Giant Pituitary Adenoma: Long-Term Outcome after Surgical Treatment of 61 Cases.

Kim, Chi Heon; Kim, Chae Yong; Kim, Dong Gyu; Han, Dae Hee; Chi, Je G; Jung, Hee Won

Original Article

Journal of Korean Neurosurgical Society 2003;34(2): 91-95.

Chi Heon Kim, Chae Yong Kim, Dong Gyu Kim, Dae Hee Han, Je G Chi, Hee Won Jung

¹Department of Neurosurgery, Seoul National University, Seoul, Korea. hwjung@snu.ac.kr
²Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea.
³Neuroscience Research Institute, Medical Research Center, Seoul National University, Seoul, Korea.

ABSTRACT

OBJECTIVE
The authors perform a retrospective analysis in order to evaluate long-term outcome results after surgical treatment of giant pituitary adenoma (PA) and to suggest the optimal treatment strategies. METHODS: From 1990 to 2001, we experienced 61 cases of giant PA, the mean size was 4.8cm. The mean follow-up period was 47 months. There were 30 cases of functioning PA and 43 of invasive adenomas. Transsphenoidal approach (TSA) was performed in 47 patients, craniotomy in 6, and a staged operation (TSA followed by craniotomy) in 8. Gross total/near total removal (over 95% removal) was performed in 9 patients (TSA in 8 and craniotomy in one) and subtotal removal (over 50% and less than 95%) in the others. Post-operative radiotherapy (RTx) was performed in thirty-six patients. Treatment results were classified as controlled and non-controlled group. Controlled group was defined as patients with no evidence of mass growth, improvement of mass effect, and endocrinological normalization.
RESULTS
Tumor control was possible in 58% and mass control only was observed in 91%. Additive radiotherapy showed a significant benefit on tumor control (p=0.013) in the subtotal removal group. In patients with functioning PA, endocrinological improvement (normalization 32%) was shown in 92% (Radiotherapy, 20 cases).
CONCLUSION
Total removal of giant PAs through TSA or craniotomy is not always feasible and often risky. Subtotal resection of giant PAs by TSA with or without subsequent RTx may provide a good local tumor control.

Key Words: Giant pituitary adenoma; Radiotherapy; Transsphenoidal approach