Giant Pituitary Adenoma – Special Considerations

Giant pituitary adenomas (GPAs) comprise 5% to 15% of pituitary adenomas, but have higher rates of extrasellar invasion, subtotal resection, surgical morbidity, and recurrence. With the possible exception of giant prolactinomas, GPAs require surgical decompression. On review of 3 decades of case series encompassing 699 microsurgical transsphenoidal (MT), 1060 endoscopic endonasal trans-sphenoidal (EET), and 513 transcranial (TC) patients, gross total resection and recurrence rates were comparable across modalities, but the EET approach had lower perioperative mortality and superior restoration of visual function. Each approach has unique indications. Combined EET-TC approaches for minimizing residual tumor represent another area of study.