Endoscopic endonasal approach for giant pituitary adenomas: surgical experience from a series of 25 consecutive cases

Giant pituitary adenomas (GPAs) are surgically challenging tumors. Endoscopic endonasal approaches (EEAs) have been increasingly preferred for excision of GPAs. In this study we present our experience in managing GPAs using EEA.

We retrospectively reviewed 25 consecutively operated patients of GPAs (size ≥ 4 cm & volume of > 10 cm³) who underwent surgical excision via EEA. Clinical symptoms, visual status, endocrine dysfunction, extent of resection (EOR) and surgical complications were studied.

The study included 16 male & 9 female patients with an average age of 33.3 years. Fifteen patients had nonfunctional, while 10 had functional tumors. The most common presenting symptom was visual dysfunction, observed in all patients. The average maximum tumor diameter was 4.9 cm, with a preoperative volume of 34.02 cc. Gross total resection (GTR) was achieved in 56% of patients, near-total resection in 40%, and subtotal resection in 4%. Radical resection (>90%) was accomplished in 96% of cases. The presence of cavernous sinus invasion & tumor consistency were significant predictors of GTR. Visual functions improved in 23 (92%) patients, with no change in two (8%). Endocrine improvement & new dysfunction occurred in 2 patients (8%) each. Complications included temporary DI in 10 (40%) & permanent DI in one patient (4%). Two patients (8%) had early postoperative CSF leaks, managed with lumbar drainage, & one required re-exploration for delayed CSF leak. No patient experienced intraoperative vascular injury or perioperative mortality.

Our study demonstrates that EEA offers high resection rates & visual improvement with acceptable morbidity, making it a safe and effective approach for managing GPAs.