Giant Pituitary Adenomas: Surgical Outcomes of 50 Cases Operated on by the Endonasal Endoscopic Approach

Surgical outcomes of the endoscopic endonasal transsphenoidal approach for large and giant pituitary adenomas: institutional experience with special attention to approach-related complications

“…Complete resection is often a technical challenge, even for experienced neurosurgeons, considering that this subgroup of tumors may present with a high degree of invasion of neurovascular structures and large areas of supra-and parasellar extension 11,23 . In this way, the primary objective of surgery includes relief of mass effect by obtaining maximal tumor resection in order to decompress visual pathways, neurovascular structures and the pituitary gland 6,9,15 . The possible route to reach the sellar region in the management of giant pituitary adenomas can be divided into two main groups: the transcranial and the transsphenoidal approaches, either microscopic or endoscopic.…”

“…It is worth emphasizing that only one purely endoscopic surgical series was included in their analysis, since the manuscript by de Paiva Neto et al 24 was mainly microscopic transphenoidal. Thereafter, few studies came out in the literature addressing the outcomes of patients undergoing resection for large and giant pituitary adenomas by the endoscopic approach 6,8,10,11,13,14,15,16 . Their main surgical outcomes and complications rates are detailed on Tables 3 and 4 …”

“…Such higher rates of GTR are quite encouraging in comparison to the open and microscopic transsphenoidal groups (9.6% and 30.9%, respectively) 7 . It is worth discussing that cavernous sinus involvement is reported by most of the studies as the major limitation to GTR with the endoscopic approach 6,8,14,16 , whereas for the microscopic transsphenoidal approach is the suprasellar extension multilobular configuration and extension to the middle fossa 15 are also reported to have a negative impact on surgical resection rates by the endoscopic technique.…”

“…Large and giant pituitary adenomas comprise a different issue, which pose a significant surgical challenge 5 . The definition is based on a purely morphological criterion in the way that when the tumor achieves a diameter greater than 4 cm in any plane, it is considered giant 5,6,7 . There is no consensus, however, on the definition of large pituitary adenomas 8,9 .…”

“…Some recent reports have described the usefulness of the endoscopic endonasal route in the their management, even though its safety and effectiveness of treating large and giant pituitary adenomas is yet to be established in the literature 6,8,10,11,13,14,15,16 . Herein, we sought to investigate our institutional experience of patients who underwent endoscopic endonasal transsphenoidal approach for treatment of large and giant pituitary adenomas emphasizing the surgical results and approachrelated complications.…”