A Proposed Classification and Scoring System Predicting Gross Total Resection of Recurrent and Residual Pituitary Adenoma: A Retrospective Study.

OBJECTIVE

To identify factors influencing gross total resection (GTR) and postoperative complications in reoperation for recurrent and residual pituitary adenomas (RRPAs) and to propose a scoring system for preoperatively predicting GTR and guiding clinical decisions.

METHODS

Clinical data of 46 patients with RRPA undergoing endoscopic transsphenoidal surgery (Jan 2022-May 2025) were retrospectively analyzed. Preoperative high-resolution computed tomography, enhanced magnetic resonance imaging, and pituitary hormone testing were performed. The extent of resection (GTR/near-total/partial) was evaluated via postoperative magnetic resonance imaging by 2 neurosurgeons independently. Pearson's χ2 and Mann-Whitney U tests were used (P < 0.05).

RESULTS

GTR was achieved in 32 (70%) patients, near-total in 13 (28%), and partial in one (2%). Knosp grade was the only factor differed significantly between the GTR and non-GTR groups (P = 0.0482). Tumor invasion (5 types) correlated with surgical difficulty. The proposed scoring system showed a lower GTR when the score ≥5 (P = 0.0208). Postoperative complications included cerebrospinal fluid (CSF) leakage (15%) and hypopituitarism (37%), and intraoperative CSF leakage was a risk factor (P = 0.0096). Of the 11 patients with functional adenomas, 82% achieved hormonal remission.

CONCLUSIONS

Knosp grade affected the GTR of RRPAs. The types of RRPAs and the proposed scoring system may provide a supplementary reference for preoperative evaluation in RRPA surgery. Intraoperative CSF leakage predicts postoperative CSF leakage.