• Anne-Laure Bernat, Pénélope Troude, Stefano Maria Priola, Ahmad Elsawy, Faisal Farrash, Ozgur Mete, Shereen Ezzat, Sylvia L Asa, John De Almeida, Allan Vescan, Eric Monteiro, Joao Paulo Almeida, Gelareh Mohammed Zadeh, and Fred Gentili.
• Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Neurosurgery, University of Paris, Lariboisière Hospital, Paris, France. Electronic address: annelaure.bernat@aphp.fr.
• World Neurosurg. 2021 Feb 1; 146: e341-e350.

IntroductionEndoscopic endonasal approaches (EEAs) provide improved access and operative visualization for resection of pituitary adenomas. Although the technique has gained wide acceptance, there is a paucity of data regarding late recurrence.ObjectiveWe aim to assess long-term outcomes of patients with nonfunctioning pituitary adenomas (NFPAs) who underwent EEA.MethodsWe reviewed 269 patients operated on for an NFPA between 2005 and 2015. Clinical and radiologic factors including those potentially related to higher chances of recurrence were analyzed. Progression-free survival was analyzed using the Kaplan-Meier method, and univariate and multivariate survival were analyzed using a Cox regression model.ResultsThe study included 269 patients. The gross total resection rate was 46.0% (n = 124) but cavernous sinus involvement was present in almost half the patients (n = 115). The probability of recurrence at 5 years and 10 years was 22.0% and 47.2%, respectively. The median time to recurrence was 10 years for patients without cavernous sinus involvement and 6 years for those with cavernous sinus involvement. Univariate and multivariate analysis showed that tumor size, cavernous sinus invasion, anterior skull base extensions, and residual tumor were significantly associated with recurrence.ConclusionsRecurrence rate of NFPA remains high despite the better visualization offered by EEA, especially in those tumors involving the cavernous sinus and/or previously operated on. Repeat surgery is adequate for tumor debulking and decompression of the optic apparatus but is unlikely to achieve gross total resection if a successful previous EEA has been performed. Radiation therapy is an effective option for management of recurrent tumors.Copyright © 2020 Elsevier Inc. All rights reserved.

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