Surgical Management of Giant Pituitary Adenomas.

Kim, Jong Hyun; Park, Kwan; Cho, Byung Moon; Nam, Do Hyun; Lee, Jung Il; Hwang, Soon Gu; Kim, Jong Soo; Hong, Seung Chyul; Shin, Hyung Jin; Eoh, Whan

Original Article

Journal of Korean Neurosurgical Society 1999;28(11): 1605-1612.

Jong Hyun Kim, Kwan Park, Byung Moon Cho, Do Hyun Nam, Jung Il Lee, Soon Gu Hwang, Jong Soo Kim, Seung Chyul Hong, Hyung Jin Shin, Whan Eoh

Department of Neurosurgery, Samsung Medical Center, Sung Kyun Kwan University School of Medicine, Seoul, Korea.

ABSTRACT

OBJECTIVE
Giant pituitary adenomas are rare. The location of these adenomas are close to vital neural and vascular structures with widespread extensions that makes the radical surgical management difficult.
METHODS
From October 1994 to August 1998, we experienced 20 patients with giant pituitary adenomas out of 178 surgically treated pituitary adenoma patients. Giant pituitary adenoma was diagnosed on the basis of the longest diameter of being more than 4cm in MRI scan. We reviewed the clinical presentation, types of tumor, size and degree of suprasellar or parasellar extension, routes of surgical approach, postoperative surgical outcomes and complications.
RESULTS
The incidence of giant pituitary adenomas was 11%. The most common chief complaint was visual disturbance(n=16). The non-functioning adenoms(n=16) were the majority and the other 4 patients were functioning adenomas(prolactinoma n=2, acromegaly n=1, cushing's disease n=1). The patients underwent transsphenoidal approach(TSA)(n=15) or transcranial approach(TCA)(n=5). Gross total or subtotal removal were achieved in 60% of TSA group(9 of 15) and 40% of TCA group(2 of 5). Postoperative complications were in 6 patients with TSA; cerebrospinal fluid(CSF) leakages(n=2), postoperative bleeding(n=2), transient diabetes insipidus(DI)(n=2). Visual function was improved in 69%(9 of 13) after TSA and 40% after TCA. Surgical results in the TSA group were better than those in transcranial approach group, and there were fewer and less severe postoperative complications.
CONCLUSION
Even in the giant pituitary adenomas, conventional transsphenoidal approach was effective as the initial treatment modality in terms of effective decompression, functional recovery, and low morbidity.

Key Words: Giant pituitary adenoma; Transsphenoial approach; Transcranial approach