Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Background & objectives: Pituitary adenomas are the third most common intracranial neoplasm, accounting for 14.4% in autopsy studies and 22.5% in radiological studies, although only about 10% are symptomatic. Recurrent pituitary adenoma is defined as recurrence of previously removed tumor, while the regrowth of a persistent, incompletely excised tumor is defined as residual pituitary adenoma. Both are customarily placed under the general category of recurrence. Patients and methods: In our study, we have discussed the diferencebetween of incomplete resection of pituitary adenoma after endoscopic endonasal trans-sphenoidal removal and factors favoring the outcome such as bony work, surgeon`s experience, size of the tumor, cavernous sinus invasion and the avoidance of the diphragmasellea descending. Results:In our study, 22 cases (recurrent acromegaly),11 were operated by transnasl trans sphenoidal approach and 11 cases were operated by gamma knife.The factors affecting the outcome were studied.We found that, there is a favor for trans sphenoidal surgery over the gamma knife, due to high rates in reduction of GH , less need for medical therapies and less time for achieving remission.Conclusion:Our study wants to demonstrate that, in a highly selected group of acromegalic patients subjected to previous surgery at our center, both gamma knife stereotactic radiotherapy and sphenoidal surgery were effective and safe

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