Surgical Treatment of Giant Pituitary Adenomas: Strategies and Results in a Series of 79 Consecutive Cases

Presentation and surgical results of incidentally discovered nonfunctioning pituitary adenomas: evidence for a better outcome independently of other patients' characteristics

“…All surgical procedures have been performed by two experienced and dedicated neurosurgeons using a standard microsurgical technique (20). The diagnosis of NFPA was based on the clinical and biochemical absence of hormone hypersecretion and the histopathological confirmation of a pituitary adenoma.…”

Size does not matter. The intrigue of giant adenomas: a true surgical challenge

“…The same principles are valid in cases of giant adenomas, where the extended approach has proved to facilitate, in most instances, a wider lesion exposure just after the dural opening over the sellar-suprasellar space, thus avoiding any retraction of neurovascular structures [16][17][18][19]. However, there are conditions that could render more troublesome the transsphenoidal approach, either related to the anatomy of the surgical route or to the inner features of the lesion itself, i.e., the size of the sella, its degree of ossification, the size and the pneumatization of the sphenoid sinus, and/or carotid arteries position and shape [1,6,20,21].On the other hand, transcranial surgery should be preferred when tumors present with extensive intracranial invasion, with asymmetric lateral development, into the anterior cranial fossa or lateral or posterior extension into the middle and posterior cranial fossa, particularly if major vessel involvement is present and/or whether transsphenoidal surgery has been already unsuccessful, and in these regards, several authors have reported surgical strategy and results, properly addressing indications, pros, and cons [22][23][24].When perceiving this controversial scenario, we moved backward through our series and analyzed the decisionmaking process, i.e., surgical approach choice, in those special-featured adenomas (giant, asymmetric, dumb-bell shaped). Although it is not possible to define a unique paradigm of management, we could thread a common line of attitude we have been relying on.…”

“…On the other hand, transcranial surgery should be preferred when tumors present with extensive intracranial invasion, with asymmetric lateral development, into the anterior cranial fossa or lateral or posterior extension into the middle and posterior cranial fossa, particularly if major vessel involvement is present and/or whether transsphenoidal surgery has been already unsuccessful, and in these regards, several authors have reported surgical strategy and results, properly addressing indications, pros, and cons [22][23][24].…”

Spontaneous Regression After Standard Transsphenoidal Surgery in a Huge Pituitary Adenoma With Epidural Extension -Case Report-

“…2) Non-functioning adenomas account for 33.9% of all pituitary adenomas, 2) whereas 73.7% of giant pituitary adenomas are non-functioning adenomas. 6) Generally, huge non-functioning pituitary tumors grow within the confines of the enlarged and ballooned sella. 5) In contrast, extension of this type of tumor into the sphenoidal or other paranasal air sinuses is relatively rare.…”

“…Giant pituitary adenomas, defined as those measuring at least 4 cm in maximum diameter, 1,2,6) account for 4.4% of all pituitary adenomas. 2) Non-functioning adenomas account for 33.9% of all pituitary adenomas, 2) whereas 73.7% of giant pituitary adenomas are non-functioning adenomas.…”