Introduction: To report the long-term outcomes after an endoscopic endonasal transsphenoidal resection of clinically nonfunctioning pituitary macroadenomas.

Methods: This is a retrospective review of a prospectively collected database. All patients underwent a pure endoscopic transsphenoidal resection of a nonfunctioning pituitary macroadenoma. Patients were included if they had at least 5 years of clinical and imaging follow up. Patient records were reviewed for neurological and endocrinologic outcomes, recurrences, and additional surgical procedures.

Results: Eighty patients met the study criteria. Visual deficits were present in 52% of patients. Seventy-one percent of patients had no residual on MRI at 1-year follow up. Patients with Knosp grade 0-2 tumors and tumor volumes <10 cm3 were significantly more likely to have received a gross total resection compared to patients with Knosp grade 3, 4 tumors or volumes >10 cm3. At long-term follow up, there were 7 (12%) recurrences in patients who had received grossly complete resections. In patients who had subtotal resections, five patients underwent secondary treatments within 12 mo of ETSS. Eighteen patients with subtotal resections were managed expectantly with annual neurological exam and MRI. Among these patients, 11 (61%) progressed radiographically and 3 (17%) had symptomatic progression. Knosp score, surgical and radiographic evidence of invasion, and preoperative visual deficits were predictive of recurrence in a univariate analysis. Overall, twenty five percent of the patients had stereotactic gamma knife radiosurgery, and 9% of patients had repeat transsphenoidal surgery for residual or recurrent tumors. Five percent of patients had major surgical complications.

Conclusions: At long term follow up 12% of patients had recurrent tumors after gross total resection. Recurrent or residual tumors were treated with either repeat surgery or GKRS. Rates of complete resection, postoperative surgical and endocrinological complications, and additional surgical procedures are similar to previously published reports after microscopic transsphenoidal surgery.

Patient Care: This study reports the long term outcomes, additional procedures, and complications of endoscopic surgery.

Learning Objectives: 1.) The incidence of tumor recurrence after a grossly total resection is 12%. 2.) The rate of radiographic progression after subtotal resection is 61% without further treatments.

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