Surgical Outcomes of Primary Versus Revision Transsphenoidal Resection for Pituitary Adenomas at a High-Volume Center
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INTRODUCTION: Pituitary adenomas are relatively common tumors managed by skull base surgeons, with a prevalence rate of 16.7% in the general population. Sub-total resection can occur when the tumor is particularly difficult, there is cavernous sinus invasion or there is relative inexperience of the surgical team. The objective of this study was to compare the surgical outcomes of primary transsphenoidal resection (TSR) of pituitary adenomas versus revision surgery of subtotally resected tumors at a high-volume brain tumor center. METHODS: The authors retrospectively reviewed the medical records of 503 consecutive patients who had undergone TSR for a pituitary adenoma at our institution from 2007 to 2015. Two categories of patients were established: 1) those who underwent a primary TSR at our institution and 2) those who underwent a revision TSR at our institution after having underwent a primary TSR at an outside institution. RESULTS: Our current cohort consisted of a total of 250 patients. Of these, 89 underwent a Primary TSR (Category 1), 33 underwent a Revision TSR (Category 2), and 128 were not included due to incomplete information on preliminary survey. Statistical analysis revealed a significant similarity between the surgical outcomes and complications of the two categories of patients. Analyzed data included extent of resection (P = .85), resolution of symptoms (P = .69), length of stay ([LOS] P = .06), chronic diabetes insipidus ([DI] P = 0.13), transient DI (P = 0.18), post-operative CSF leak (P = .10), new hypopituitarism (P = .56), meningitis (P = .29), neural deficit (P = .29), epistaxis (P = .46), and suprasellar hematoma (P = .80). All measurements of surgical outcome and post-operative complications did not meet the level of significance to be considered statistically different. CONCLUSIONS: High-volume centers are able to achieve similar surgical outcomes in revision vs. primary TSR despite the challenges that recurrent or residual disease may present. These results suggest that patients who undergo subtotal resections may benefit from referral to a high-volume center for consideration of a repeat resection before radiation or other adjuvant therapies are initiated.