Non-functioning pituitary macroadenomas (NFPMA) are the commonest pituitary tumour requiring surgery. There are no published series regarding the surgical outcomes from Australia. We describe surgical outcomes and regrowth rate at a single centre.
Methods: Retrospective analysis of all NFPMA cases with pituitary surgery between September 1995 and December 2014.
Cohort:
178 cases identified. Males 54%, mean age 56.2±14.9 years.
Symptomatic presentation occurred in 61% (N=109) of which headache was the commonest complaint (N=69; 39%). Incidental presentation 29% (N=51); apoplexy in 10% (N=18). Visual deficit was reported in 67% (N=120).
Surgery:
The trans-sphenoidal approach was used in all except one who underwent the trans-cranial approach. Senior neurosurgeon (PMcN) performed 71% surgeries, the remainder were performed by five other neurosurgeons.
A single operation occurred in 155 (87%). Two operations were performed in 20 (12%) and three in 3 cases (3%). In 23% (N = 6) repeat surgery was planned in the immediate post operative period. In 48% (N = 11) repeat surgery was performed at a mean follow up time of 55.3 months, no data for timing of repeat surgery in the remainder
Post-operative complications: CSF leak (N=14; 8%), transient DI (N=27; 15%), permanent DI (N=12; 7%), SIADH (N=14; 8%), significant infection (N=3; 2%), significant bleeding (N=2; 1%), post-operative cardiac events (N=2; 1%).
Surgical Follow up:
One hundred and thirty-five patients (76%) had radiological follow-up ≥12 months, mean follow-up 81.8 (range 12-226). Thirty-three patients (24%) demonstrated tumour regrowth. Mean time to tumour regrowth was 59.7 months. Residual tumour was a significant risk factor for tumour regrowth (38% vs 15%; p=0.02). Treatment for tumour regrowth was surgery in 42% (N = 14), radiotherapy in 24% (N = 8) and combined approach in 15% (N = 5).
Discussion:
Tumour regrowth rate following trans-sphenoidal pituitary surgery is low, consistent with other international series.