OBJECTIVE: Complete removal of a pituitary adenoma is a challenging endeavor. Recurrent or residual pituitary adenoma is a frequent occurrence following microscopic, endoscopic, or craniotomy procedures. The objective of this investigation is to assess the effectiveness of the endoscopic endonasal transsphenoidal technique in removing recurrent and persistent pituitary adenomas. Methods: We conducted a prospective analysis of twenty cases who had endoscopic endonasal surgery for recurring or residual pituitary adenomas between 2016 and 2020, following previous microscopic or endoscopic transphenoidal operations. Results: we achieved gross total resection in 6 patients (30%) and 14 (70%) subtotal resection. 2 of them were operated microscopically in the previous surgery. All those six patients have the adenoma limitted to the sellar and suprasellar space. Extension to the parasellar space is one of limiting the total excision. Mortality occurred in one patient who was complicated by intraoperative csf leak and subarachnoid hge and brain stem and cerebellar infarction. Conclusions: excision of recurrent pituitary adenoma by endoscopic endonasal transsphenoidal approach is a safe, effective & advantageous method in treating recurrent pituitary adenoma. Factors that limit total resection are: parasellarextention, prolonged dopamine antagonists’ therapy and tumor size. The presence of suprasellar extension didn't limit the extent of resection and might provide an advantage over microscopic speculum-based techniques.

Recurrent, pituitary adenoma, endonasal, transphenoidal, sellar, suprasellar and parasellar.