[Repeated transsphenoidal surgery for pituitary adenomas].

It is well known that the risks in patients subjected to repeated transsphenoidal surgery are higher than in patients without prior therapy. The authors report their experience of repeated transsphenoidal surgery in 18 pituitary adenoma cases, 7 as the second step of two staged operation, 7 for recurrent adenomas and 4 for the postoperative CSF rhinorrhea. Technical points in re-opening and closure of the transsphenoidal route are presented. A huge adenoma with suprasellar extension may be successfully removed by two staged operation. Some adenomas become less hemorrhagic at the second operation. Recurrent adenomas are also safely operated when the goal of the surgery is limited to the decompression of the optic nerve with sparing the pituitary function. CSF rhinorrhea is easily controlled by packing the sella turcica and the sphenoid sinus with one piece of fat for each compartment.