Diagnosis and treatment for giant pituitary adenomas

He Zhenhua; Yuan Jingmin; Li Qiang; Zhang Xinding; Pan Yawen; Shi Xuefeng; Lan Zhengbo

doi:10.11850/j.issn.1009-122X.2014.11.004

Abstract：Objective To explore the surgical outcome and complications of limited removal in several sessions for giant pituitary adenomas via endoscopic transsphenoidal approach or in combination with pterional approach. Methods Clinical data of 45 patients with giant pituitary adenomas were analyzed retrospectively, who underwent fractional resection by craniotomy via endoscopic transsphenoidal or combined with pterional approach. The clinical outcome and postoperative complications were observed. Results In the first surgery, total removal was achieved in 26 patients, subtotal removal in 12, partial removal in 7. Nine patients got total resection and 6 got subtotal removal in the second surgery. The optimal interval between the two operations was 6 to 8 weeks. The postoperative complications included transient diabetes insipidus in 13 patients, cerebrospinal fluid nasal leakage in 5, central hyponatremia in 2, central high fever in 10 and hypopituitarism in 12. All the above symptoms were improved or disappeared after symptomatic support treatment. Sphenoid infection occurred in 3 patients including improvement in 2 by endoscopic debridement and recovery in 1 by anti-inflammatory treatment. Thirty-nine patients were followed up for 2 months to 3 years at a mean period of 2.1 years. The recurrence occurred in 9 patients including 6 receiving surgery again and 3 giving up. Conclusions Staged endoscopic transsphenoidal surgery combined with pterional approach could be an effective method for increasing total removal rate and decreasing the mortality and complications of giant pituitary adenomas.