[Hypophyseal macroadenomas. A neurosurgical challenge]

Area of Science:

• Neurosurgery
• Endocrinology
• Oncology

Context:

• Pituitary adenomas larger than 10 mm present significant management challenges due to proximity to critical neurovascular structures.
• A cohort of 336 patients with large pituitary tumors ( > 10 mm) was analyzed to evaluate surgical outcomes.
• The study highlights the clinical presentation, demographics, and tumor characteristics of patients undergoing surgery for pituitary adenomas.

Purpose:

• To analyze surgical results for large pituitary adenomas (> 10 mm).
• To evaluate the efficacy of the transsphenoidal approach versus craniotomy for tumor removal and patient outcomes.
• To propose recommendations for selecting optimal surgical strategies and minimizing complications in pituitary adenoma management.

Summary:

• The study analyzed 336 patients with pituitary tumors > 10 mm, predominantly female, averaging 43.2 years. Headache and visual deficit were common symptoms, with only 25% of tumors being functioning.
• Transsphenoidal surgery was the primary approach (72% complete removal), achieving 68% visual recovery, especially in patients with shorter clinical courses. Functioning tumors had lower cure rates (34/84).
• Complications correlated with tumor growth patterns and consistency. Craniotomy, though associated with higher morbidity/mortality, was used for more complex lesions. Recommendations and a treatment diagram are provided.

Impact:

• The findings provide evidence-based recommendations for surgical approach selection in pituitary adenoma management.
• Improved understanding of factors influencing visual recovery and cure rates in functioning pituitary adenomas.
• The study contributes to reducing morbidity and mortality by guiding surgical decisions and complication avoidance for large pituitary tumors.