Patients with visual failure form the largest transcranial group in the authors' series of recurrences. In patients with recurrent tumors, complete tumor removal is not a realistic goal if adverse prognostic features, such as cavernous sinus invasion, are present on magnetic resonance imaging (MRI) scan. With a functioning adenoma, a repeat transsphenoidal operation may be indicated. When the main symptom is visual failure and if it is clear that complete resection is not possible, the best approach is often to treat the symptomatic suprasellar component via a craniotomy.
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