Radiologic, neurosurgical, endocrinological and radiotherapy records of all patients (N = 131) with a NFA who were operated upon at the University Medical Center Groningen between 1979 and 1998 were reviewed. All patients had histologically and endocrinologically verified NFAs. Nine out of 131 patients were not included in this series because they were lost to follow-up. The remaining 122 patients were included in the analysis.
The study population consisted of three distinctive groups:
Group 1 consisted of 76 patients (62%) with radiologic evidence of residual NFA, who received immediate postoperative radiotherapy after the first operation. Twenty-six of these patients were operated transcranially (34%) and 50 by the transsphenoidal route (66%) (see Table 1). The median time between surgery and the start of radiotherapy was 5.8 months; it is just possible to decide on computed tomography (CT)/magnetic resonance imaging (MRI), performed 3 to 4 months after operation, if there is residual pituitary adenoma, because mass effects due to operation have disappeared after that time period.

Table 1 (click to view)

The median follow-up time between radiotherapy and last MRI was 93 (range, 14 – 248) months.
Group 2 consisted of 28 patients (23%) with radiologic residual NFA after neurosurgery in which the consultant endocrinologist decided for a wait-and-see policy. Twenty-one of these patients (75%) underwent a transsphenoidal procedure while in 7 patients (25%) a craniotomy was performed (see Table 1). The median follow-up time between operation and last MRI was 71 (range, 3 – 206) months.
Group 3 consisted of 18 patients (15%; 12 after transsphenoidal surgery and 6 after craniotomy) without radiologic evidence of residual NFA after surgery. Three patients in this group received immediate postoperative radiotherapy.