Short-Term Results of Surgical Treatment for Giant Pituitary Adenomas

Abstract

Objective: The aim of this study is to analyze short-term results of surgical treatment for giant pituitary adenomas. Design: Retrospective study. Materials and Methods: Tumors with maximum a diameter >40 mm at diagnosis were defined as giant adenomas in this study. Resection rate, complications, and visual status were analyzed. Particularly, we adopted visual impairment score (VIS) for evaluation of pre- and postoperative visual status. Twenty-two cases that were treated between January 2001 and October 2011, including 19 nonfunctioning adenomas and 3 functioning adenomas, were enrolled in this study. Results: Thirteen cases were women, and the mean age was 54.4 years. The mean diameter of tumors was 47.1 mm. Except for one case, aggravation of visual function was the first complaint. A total of 28 operations were conducted. The transcranial approach (TC) was performed in 12, transsphenoidal surgery (TSS) in 13, and combined surgery in 3. The skull base technique was adopted in five operations in the TC series, and 4 in TSS series were performed with endoscope. Gross total, subtotal, and partial resection was achieved in 21%, 19%, and 60% of the cases, respectively. Although there was no mortality, 16 severe surgical complications, involving 2 cerebral infarctions, 6 panhypopituitarism, and 8 diabetes insipidus, were observed. Postoperative mean VIS was improved; however, the visual status deteriorated in two cases. Conclusions: This study showed that visual status could be preserved in most of the cases by applying various surgical approaches. However, surgical strategies should be improved because results of resection rate and complications were still unsatisfactory.