Management of large and giant pituitary adenomas with suprasellar extensions

OBJECTIVE AND BACKGROUND: We evaluated the feasibility and effectiveness of transsphenoidal surgery for large and giant pituitary adenomas with suprasellar extensions as these tumors have been therapeutic challenge. SUBJECTS AND METHODS: We retrospectively analyzed 50 cases with 56 surgeries in patients with pituitary adenomas that were surgically treated between January 2005 and January 2010 at Fujita Health University. Among those cases, 39 cases were large or giant pituitary adenomas including 11 cases of giant adenomas. RESULTS: 37 cases 41 approaches were transsphenoidal, 2 approaches were transcranial, and in 1 case transcranial approach following transsphenoidal surgery was performed. The most frequent preoperative symptoms were visual impairment and visual field defect (28 cases, 75.6%), and improvement of visual function after surgery was observed in 18 cases, 64%. As endocrinological results, among the 11 cases of functioning adenomas, improvement of endocrinological examination was observed in 10 cases, and normalization of the hormonal examination and complete remission was seen in 7 cases which was 64%. CONCLUSIONS: Transsphenoidal approach is safe and effective procedure even in large or giant pituitary adenomas, because it allows rapid and appropriate decompression of the optic nerves and chiasm with low morbidity rates. Transcranial approaches were indicated only in irregular shaped adenomas or eccentric extensions that could not be reached through the transsphenoidal route.