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Journal of Korean Neurosurgical Society > Volume 34(2); 2003 > Article
Journal of Korean Neurosurgical Society 2003;34(2): 91-95.
Giant Pituitary Adenoma: Long-Term Outcome after Surgical Treatment of 61 Cases.
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
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