The surgical treatment of large pituitary adenomas

The problems associated with the treatment of large pituitary adenomas are discussed with reference to 41 patients operated on by the author. All adenomas had either suprasellar extensions greater than 2 cm and/or more than two intracranial extensions. Ninety-five per cent were suffering from chiasmal compression pre-operatively. All underwent transfrontal surgery with 76% being deemed totally excised and 24% being subtotal. After surgery 29% regained normal vision, 53% had improved vision and 18% had unchanged vision. Thirty-four per cent had no postoperative complications and the majority had a variety of complications, some minor and some major. Other aspects, including endocrinology and recurrence, are also discussed.