Long-term outcomes after endoscopic endonasal surgery for nonfunctioning pituitary macroadenomas.

Area of Science:

• Neurosurgery
• Endocrinology
• Oncology

Background:

• Nonfunctioning pituitary adenomas are slow-growing tumors.
• Tumor recurrence or progression after resection may necessitate further treatment.
• Understanding long-term outcomes is crucial for patient counseling and decision-making.

Purpose of the Study:

• To evaluate long-term recurrence and progression rates after endoscopic endonasal surgery (EES) for nonfunctioning pituitary macroadenomas.
• To identify predictors of recurrence and progression.
• To inform clinical management strategies.

Main Methods:

• Retrospective analysis of 190 patients undergoing EES (2003-2014) with at least 5 years of follow-up.
• Tumor volumes measured via MRI; recurrence defined as ≥0.1 cm³ post-GTR.
• Progression defined as ≥25% increase in residual tumor post-STR.

Main Results:

• Gross-total resection (GTR) achieved in 66.8% of patients.
• Five- and 10-year recurrence rates after GTR were 3.9% and 4.7%, with low treatment need (0.79%-1.6%).
• After subtotal resection (STR), 5- and 10-year progression rates were 21%-24.5%, with 17.5%-21% requiring intervention, especially with cavernous sinus location or >1 cm³ tumors.

Conclusions:

• Long-term recurrence after GTR for pituitary adenomas is low.
• Observation may be a viable strategy after STR, potentially avoiding prophylactic radiation.
• Tumor volume, Knosp score, and Ki-67 are useful for guiding follow-up intensity.