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Updated: May 5, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Predicting tumor progression in non-functioning pituitary macroadenomas following transnasal transsphenoidal
Viktor M Eisenkolb1, Patricia Schneider1, Michel Mondragon-Soto2
1Department of Neurosurgery, TUM Klinikum, Technical University of Munich, Munich, Germany.
Introduction:
This retrospective, single-center study aimed to identify predictive factors for progression in postoperative residual findings of non-functioning pituitary macroadenomas (NFPMAs). The findings are intended to support individualized decisions regarding follow-up and adjuvant therapy.
Methods:
A retrospective analysis was conducted on 212 patients treated at a tertiary referral center between 2007 and 2023. Patients underwent MRI-guided, transnasal transsphenoidal surgery for histologically confirmed NFPMAs. Pre- and postoperative tumor volumes were assessed alongside demographic, clinical, and histopathological data. Tumor configuration was classified using Hardy and Knosp scales. Subgroups were defined based on postoperative imaging: stable residuals, progressive residuals, or recurrence after gross total resection (GTR). Statistical analyses included multivariate testing and ROC analysis to determine predictive cutoff values.
Results:
Of the 212 patients, initial radiological gross total resection (GTR) was achieved in 94/212 (44.3%); during follow-up, 62/212 (29.2%) had durable complete resection without recurrence, while 32/212 (15.1%) developed recurrence after initial GTR. Among patients with residual findings, 76 (64.4%) exhibited stable tumors after a mean of follow-up of 39 months, while 42 (35.6%) showed progression, which correlated significantly with larger preoperative tumor volumes (median: 11.6 cm3 vs. 5.81 cm3, p < 0.001). ROC analysis identified 7.12 cm3 as the optimal cutoff for distinguishing stable from progressive residual tumor volumes (AUC = 0.748). No significant differences between stable and progressive groups were observed in Hardy or Knosp classifications. Postoperative cortisol levels were nominally higher in patients with progressive residuals (14.10 μg/dL vs. 10.83 μg/dL; p = 0.022; exploratory).
Conclusion:
According to our study, preoperative and postoperative tumor volumes represent pragmatic prognostic markers of progression in NFPMAs, with a critical cutoff of 7.12 cm3 for stability. These findings could inform tailored follow-up strategies. Prospective studies are warranted to validate these results and further explore the impact of surgical and tumor characteristics on long-term outcomes.
