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BackgroundNo scoring system is available to predict the extent of resection of giant pituitary adenomas (GPAs) based on magnetic resonance imaging (MRI) parameters. We developed a novel AKU Giant Pituitary Adenoma (AGPA) score and assessed the predictive ability of the scoring system concerning the extent of resection of GPAs. MethodologyWe retrospectively collected data of patients presenting with GPAs and used our scoring system to assess the surgical resection of these tumors. The Lundin-Pederson (ABC/2) method was used to calculate the pre-and post-resection tumor volume. The relationship between the extent of resection and the AGPA score was assessed using linear regression. The AGPA score considered the tumor's extension into various planes. The maximum total score was 9. ResultsThe scoring system was applied to 45 patients with GPA who underwent surgical resection. The mean resected tumor volume (%) was 82.0 ± 16.7, and the overall mean AGPA score was 4.2 ± 0.8. The pairwise correlation between the resected tumor volume and the overall AGPA scores showed a strong inverse association (r = -0.633, p < 0.001). A significant difference was detected between the estimated scores of 3 and 5 and 4 and 5 (p < 0.001). ConclusionsAGPA score is inversely related to the extent of the tumor to be resected, which would help surgeons predict the amount of tumor resection possible as well as predict the difficulty of surgery and plan optimal preoperative patient counseling. In addition, it can predict if staging and a transcranial approach are required.

BACKGROUND In this study we compared giant pituitary adenomas (GPAs) and non-giant pituitary macroadenomas (nGPAs) on the basis of presenting complaints, surgical procedures, tumor resections and outcomes. METHODS A retrospective analysis (2006-2017) of pituitary macroadenomas was performed where tumors were divided into two groups; tumors greater than 4 cm were classified as GPAs while macroadenomas smaller than 4 cm were termed as nGPAs. Both GPA and nGPA had 75 patients in each group. RESULTS The most common complaint of all patients was visual deterioration (77.3% of patients with nGPAs and 89.3% of patients with GPAs). Visual field defects were present in 55 patients (73.3%) in the nGPA group compared to 68 patients (90.7%) in the GPA group (p=0.006). The mean volume of nGPAs was 6.3 cm3 (range 0.45 cm3 to 22 cm3 while the mean volume of GPAs was 30.1 cm3 (range 10.8 cm3 to149.4 cm3) (p=0.001). The mean extent of resection was 88.9% for nGPAs whereas the mean extent of resection was 76.7% for GPAs (p=0.03). Craniotomy was required only in the GPA group (5 patients, 6.7%) (p=0.023). Tumor recurrence/progression was seen in 9.3% of patients with nGPAs and 44% of patients with GPAs (p=&lt; 0.001). Re-do surgery was required in 2.7% of nGPA cases (via transsphenoidal approach) and 32% of GPA cases; in this GPA subgroup, 22.7% patients required transsphenoidal surgeries while 9.3% patients required transcranial surgeries. Stereotactic radiosurgery in recurrence/progression accounted for 4% of nGPA patients and 22.7% of GPA patients. There were 3 mortalities, all in GPA group. Overall, nGPA group had better postoperative course as compared to GPA group. CONCLUSION The frequency of preoperative symptoms in GPAs is more significant and associated with lesser chances of gross total tumor resection, higher rates of recurrence, and worse postoperative course in comparison to nGPAs.

BACKGROUND Giant pituitary adenomas (GPA) are uncommon and highly variable in morphology and extension. There is no scoring system that considers all the dimensions of adenoma invasion. We developed a new Giant Pituitary Adenoma score and report our surgical experience and evaluate outcomes after resection of these tumors in accordance with the preoperative score. METHODS We developed a novel scoring system for classifying giant pituitary adenomas, and 11-year data of GPA surgery at our center was collected retrospectively, based on this scoring system. GPA Score considered tumor’s parasellar extension, encasement of cavernous internal carotid artery (ICA), suprasellar extension &gt; 2 cm, suprasellar extension &gt; 4cm and retrosellar extension. Maximum possible score was 9. The scoring system was applied to 53 patients of GPA who underwent surgical resection between January 1, 2006, and December 2017. The Lundin-Pederson (ABC/2) method was used to calculate the tumor volume both pre- and post-resection and linear regression was used to assess the relationship between extent of tumor resection and GPA score. RESULTS The median age of the study population was 42.08 ± 16.49 years. The mean maximum diameter of the pituitary adenomas was 5.0 cm (range 4.0 cm-8.5cm) while the mean volume of the adenomas was 27.3 cm3 (range 10 cm3-149 cm3). There were 3 cases of score 2, 5 cases of score 3, 13 cases of score 4, 20 cases of score 5, 9 cases of score 6 and 3 cases of score 7. The range of tumor volumes of tumors for scores from 2-7 was 17.3 cm3 to 65.8 cm3 and GPA score was correlated with the percent residual tumor using linear regression that was statistically significant (p= 0.001). CONCLUSION GPA Score is a reliable scoring system to predict the extent and subsequent difficulty in tumor resection in GPA.