Primary versus revision transsphenoidal resection for nonfunctioning pituitary macroadenomas: matched cohort study.

Area of Science:

• Neurosurgery
• Endocrinology
• Oncology

Background:

• Nonfunctioning pituitary macroadenomas (NFPMAs) are common pituitary tumors.
• Transsphenoidal resection (TSR) is a primary surgical approach.
• Outcomes of primary versus revision endoscopic TSR for NFPMAs require comparison.

Purpose of the Study:

• To compare outcomes between primary and revision endoscopic transsphenoidal resection (TSR) for nonfunctioning pituitary macroadenomas (NFPMAs).
• To evaluate complications, resection rates, and progression-free survival (PFS) in both groups.

Main Methods:

• Retrospective review of 287 patients undergoing endoscopic endonasal TSR for NFPMAs (2005-2011).
• Fifty revision TSR patients were matched to 46 primary TSR patients.
• Analysis included complications, gross-total resection (GTR), adjuvant radiotherapy, and Kaplan-Meier PFS.

Main Results:

• No significant differences in neurological deficit, vascular injury, CSF leak, or diabetes insipidus (DI).
• Primary TSR had higher rates of SIADH (syndrome of inappropriate antidiuretic hormone) (17% vs 4%).
• Primary TSR achieved higher GTR (63% vs 28%) and lower adjuvant radiotherapy rates (13% vs 42%). Radiological PFS was similar at 5 years (87% vs 80%).

Conclusions:

• Primary endoscopic TSR for NFPMAs is associated with higher SIADH rates compared to revision TSR.
• Revision TSR yielded lower GTR rates but comparable long-term radiological PFS, potentially due to increased adjuvant radiotherapy use.
• Endoscopic TSR is effective for both primary and revision settings in managing NFPMAs.