Background: Pituitary adenoma (PA) is a benign neuroendocrine neoplasm originating from the adenohypophysis; these tumors represent about 10%- 20% of primary brain neoplasms, If the diameter of Pituitary adenomas is ≥ 4 cm they are considered as giant adenomas, representing nearly 5% of pituitary adenomas. Transsphenoidal approach is being widely used nowadays replacing the transcranial approach due to the higher morbidity and complications of the transcranial approach
This is a retrospective clinical study of 36 patients with giant pituitary adenoma operated using transsphenoidal approach in a period of 5 years at benha university hospitals.
Results: Endoscopic transsphenoidal approach was used in all cases of this study, Gross total resection was achieved in 11 cases (30.6%), subtotal resection was achieved in 14 cases (38.9%) and partial resection was performed in 9 cases (25%). Recurrence occurred in one case only, limiting factors against gross total resection were, cavernous sinus invasion, vascular tumors, solid tumors and multilobular tumors. Visual acuity was improved in 21 cases (67.7%), visual field was improved in 18 cases (69.2%), headache disappeared in 11 cases (73.3%). No mortaliy was reported the most common complication were cerebrospinal fluid leake leak and diabetes insipidus. Post-operative radiosurgery was used in 9 cases in which the removal rate was less than 70% (partial resection).
Conclusions: endoscopic endonasal transsphenoidal approach can be used safely and effectively for removal of giant pituitary adenoma with acceptable morbidity that can be managed easily, the learning curve is very important in management of these tumors, the more cases operated the better gross total resection rate