Long-Term Functional and Tumor Outcomes Following Uni-Nostril Endoscopic Surgery for Non-Functioning Pituitary Adenomas: Results in 172 Patients

Background:Long-term functional and tumor outcomes in patients undergoing endoscopic surgery for non-functioning pituitary adenomas (NFPA) are not well documented.Objective:To study factors influencing the extent of resection (EOR) and long-term visual, hormonal, and tumor outcomes following uni-nostril endoscopic surgery in patients with nonfunctioning pituitary adenomas.Methods:In total 172 patients, with >= 1 year follow-up, operated between 2005 and 2018 were included in this retrospective study. Risk factors were analyzed, with logistic regression analysis, for EOR and long-term visual and hormonal outcomes. Recurrence rates were correlated with EOR and adjuvant radiation therapy (RT).Results:Gross total resection (GTR) or near total resection (NTR) was achieved in 120 (69.7%) patients. Higher Knosp grade and previous surgery were associated with lower EOR (P = 0.02 and 0.004, respectively). On long-term follow-up (mean, 72.5 months), visual impairment score improved in 59.4% and remained the same in 38.5% of patients. The hormonal axis remained the same in 55.8% and worsened in 39.5% of patients. The 10-year recurrence rate for patients who had NTR of the tumor was 0% with RT and 63.2% without RT. Overall, the 10-year recurrence rate in the non-RT group was higher (51.2%) than the RT group (3.2%) (P = 0.001).Conclusion:Long-term visual outcome following uni-nostril surgery for NFPA is excellent or good in over 80% of patients but most patients need life-long hormonal replacement therapy. RT following surgery is associated with excellent tumor control in patients undergoing less than a GTR, but it leads to higher rates of pituitary dysfunction.