Peer-Review ReportGiant Pituitary Adenomas: Surgical Outcomes of 50 Cases Operated on by the Endonasal Endoscopic Approach
Introduction
Giant pituitary adenomas are defined as tumors larger than 4 cm in maximum diameter in any direction. They comprise 5%−16% of all pituitary adenomas in surgical series 1, 16, 29, 42, 43. This type of tumor grows slowly and, in some cases, becomes demarcated from normal pituitary tissue by a pseudocapsule (6).
The large dimension of those tumors and their proximity to important neurovascular structures in the skull base justify, partially, the low rates of gross total resection, which less than 50% in some previous studies 7, 29, 36.
Surgical resection is the main treatment option for giant pituitary adenomas. The objectives in those cases are to achieve maximal tumor resection, improve visual function and other neurological deficits, and to preserve the hormonal function of the normal pituitary gland.
In the current report, we retrospectively review the surgical outcome of patients who underwent transsphenoidal endoscopic removal of giant pituitary adenomas in our department. In addition, we discuss the factors related to the operative approach and the complications related to this procedure.
Section snippets
Study Design
A retrospective analysis of all patients who underwent endoscopic transsphenoidal surgery for skull base lesions from January 1998 to December 2011 was performed. To evaluate the patients with giant adenomas, we only included in our study cases who presented with pituitary lesions greater than 4 cm who underwent surgical treatment by the transsphenoidal endoscopic approach. Exclusion criteria included patients who had been undergone transcranial procedures, patients younger than 18 years of
Epidemiology
From 1998 to 2011, a total of 480 patients underwent endoscopic transsphenoidal procedures for treatment of sellar lesions in our department. Fifty patients of this group (10.4%) had a giant pituitary adenoma. This group was composed of 33 (66%) males and 17 (34%) females (male to female ratio was 2:1). Most of the patients were in their third and fifth decades of life (18 to 78 years, mean age: 48.2). The mean follow-up period was 5 years (range, 4 months to 13 years).
Clinical History
The main clinical
Discussion
Pituitary adenomas are benign, slow-growing tumors 7, 43. They constitute approximately 2%–17% of all intracranial tumors 27, 45. Giant pituitary adenomas represent 5%–16% of all pituitary tumors 1, 6, 14, 16, 23, 24, 30, 40, 42, 44. Pituitary adenomas may reach such large dimensions without being detected for several reasons. Patients with silent corticotrophic adenoma, patients with nonfunctional adenoma, and male patients with prolactinomas have tumors that grow slowly without significant
Conclusion
Giant pituitary adenomas represent an important challenge to neurosurgeons. Transsphenoidal endoscopy surgery is a safe and effective procedure for the treatment of patients with giant pituitary tumor, if performed by a group of surgeons who specialize in pituitary surgery. The main goal of the surgical treatment of such lesions is to achieve maximum tumor resection with minimum side effects by careful preoperative planning of the operative approach. Additionally, radiotherapy, long-term
References (45)
- et al.
Current concepts and controversies in the management of non-functioning giant pituitary macroadenomas
Clin Neurol Neurosurg
(2007) - et al.
Giant pituitary tumors: a study based on surgical treatment of 118 cases
Surg Neurol
(2004) - et al.
Long-term follow-up o large or invasvepituitary adenomas
Surg Neurol
(1986) - et al.
Pathology of pituitary tumors
Endocrinol Metab Clin N Am
(1987) - et al.
Surgical results of large and giant pituitary adenomas with special consideration of ophthalmologic outcomes
World Neurosurg
(2011) - et al.
Surgical outcome of the endoscopic endonasal approach for non-functioning giant pituitary adenoma
Journal of Clinical Neuroscience
(2011) - et al.
Simultaneous combined supra-infrasellar approach for giant/large multilobulated pituitary adenomas
World Neurosurg
(2012) - et al.
Partial surgical removal of growth hormone-secreting pituitary tumors enhances the response to somatostatin analogs in acromegaly
J Clin Endocrinol Metab
(2006) - et al.
Loss of vision after transsphenoidal surgery
Neurosurgery
(1990) - et al.
Incidence and management of complications of transsphenoidal operation for pituitary adenomas
Neurosurgery
(1987)
Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas
J Neurosurg
The ‘capsule’ of pituitary macroadenomas represents normal pituitary gland: a histopathological study
Br J Neurosurg
Surgical management of giant pituitary adenomas
Can J Neurol Sci
Complications of transsphenoidal surgery: results of a national survey, review of the literature, and personal experience
Neurosurgery
Outcomes of surgically treated giant pituitary tumours
Can J Neurol Sci
Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series
Neurosurgery
Extended endoscopic endonasal transsphenoidal approach for removal of suprasellar tumors: Part 2
Neurosurgery
Demonstration of the optic pathway in large pituitary adenoma on heavily T2-weighted MR images
Br J Neurosurg
The endoscopic versus the traditional approach in pituitary surgery
Neuroendocrinology
Giant pituitary adenomas: clinical characteristics and surgical results
Br J Neurosurg
Acromegaly Consensus Group
J Clin Endocrinol Metab
Endoscopic endonasal approach for pituitary adenoma: surgical complications in 301 patients
Pituitary
Cited by (103)
Simultaneous combined endoscopic endonasal and transcranial surgery for giant pituitary adenomas: Tips and traps in operative indication and procedure
2022, Clinical Neurology and NeurosurgeryGiant Pituitary Adenoma – Special Considerations
2022, Otolaryngologic Clinics of North America
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All authors contributed equally to the development of the manuscript.