Endonasal transsphenoidal surgery and multimodality treatment for giant pituitary adenomas.
OBJECTIVE
Giant pituitary adenomas (> or =40 mm) pose a major management challenge. We describe the experience of a single surgeon and a dedicated neuro-endocrine team with multimodality treatment of these tumours in three specialized institutions.


METHODS
Retrospective data set analyses.


METHODS
Fifty-one consecutive patients with a giant adenoma (39 endocrine-inactive, 12 endocrine-active; mean tumour diameter 45 mm) treated over 10 years by an endonasal transsphenoidal approach were included. All patients had surgical resection followed by radiotherapy and/or medical therapy as judged necessary.


METHODS
Hormonal and visual status, extent of resection, tumour control rates, complications and use of medical and radiotherapy were evaluated.


RESULTS
Surgery resulted in gross total, near total and subtotal removal in21 (41%), 10 (20%) and 20 (39%) patients respectively. Complete tumour removal was associated with absence of cavernous sinus invasion (P < 0.001). Long-term endocrine function improved in 49% of patients and new endocrinopathy occurred in 14.6%; 76% required long-term hormone replacement therapy. Vision improved in 81.5% of the patients and there was no visual worsening. At the last follow up (median 30 months), tumour control was achieved in 96% of patients: 59% with surgery alone, 20% with surgery plus focussed radiotherapy, 18% with surgery and medical therapy and two with all three modalities.


CONCLUSIONS
Endonasal surgery provides effective initial treatment for patients with giant adenomas. Multimodality therapy was needed in almost 50% of patients and this rate will likely increase with longer follow up. Close collaboration of neurosurgeons with endocrinologists and radiation oncologists is essential for optimal treatment of patients with these challenging tumours.
de Paiva Neto
Manoel Antonio
MA
Brain Tumor Center, John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
Vandergrift
Alexander
A
Fatemi
Nasrin
N
Gorgulho
Alessandra A
AA
Desalles
Antonio A
AA
Cohan
Pejman
P
Wang
Christina
C
Swerdloff
Ronald
R
Kelly
Daniel F
DF
D000236:Adenoma / Q000601:surgery* / Q000628:therapy; D000328:Adult; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D009666:Nose / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery* / Q000628:therapy; D012189:Retrospective Studies