# Giant pituitary adenomas: an institutional experience with 289 surgically treated patients

## TL;DR

This study examines surgical outcomes in 289 patients with giant pituitary adenomas, highlighting treatment challenges and complication rates.

## Contribution

The paper provides a large, single-center retrospective analysis of surgical strategies and outcomes for giant pituitary adenomas.

## Key findings

- Transsphenoidal surgery was used in 69.6% of cases, but combined approaches were needed in 18%.
- Gross-total resection was achieved in only 18% of patients, influenced by tumor size and extension.
- Severe complications occurred in 5.9% to 3.5% of cases, with a 2.4% early mortality rate.

## Abstract

Giant pituitary adenomas (GPA) are considered difficult to treat and the operative procedures are associated with more complications. This study aimed to assess treatment strategies of GPAs in a large consecutive and uniformly documented series in a single specialized center.

A total of 289 patients with GPA who underwent primary surgery in our department between December 1982 and December 2022 were analyzed in this retrospective study. GPAs were defined by a maximum diameter of ≥ 4 cm in at least one plane. Patients were reviewed for endocrine, radiological and ophthalmological outcomes as well as complication and mortality rates.

The mean maximum tumor diameter was 4.6 ± 0.7 cm. 201 patients (69.6%) underwent transsphenoidal and 36 patients (12.4%) underwent transcranial surgery only. 52 patients (18.0%) underwent a combined approach within a few weeks. Gross-total resection (GTR) was achieved in one-fifth (n = 52) of the patients. It was dependent, among other factors, on patients’ tumor size and tumor extension. Severe complications such as tumor apoplexy, meningitis or cerebrospinal fluid leaks occurred in 5.9%, 3.5% and 2.8% of patients, respectively. Seven deaths (2.4%) occurred in the early postoperative period. The median follow-up time was 76 months, at which point 70.2% of patients showed a stable condition without requiring further treatment.

Generally, the treatment of giant pituitary adenomas remains a significant challenge. Although the transsphenoidal approach achieved good results, tumor size and configuration often required a transcranial approach or a combination of different approaches. It is important to consider individual patient and tumor characteristics when selecting the most appropriate surgical approach.