Outcomes of surgically treated giant pituitary tumours.
OBJECTIVE
To evaluate the outcomes of patients with giant pituitary tumours (GPTs) who underwent a purely binasal endoscopic transsphenoidal surgery (BETS) and compare their outcomes with those achieved through craniotomy and microscopic transsphenoidal surgery (MTS).


METHODS
Seventy-two consecutive patients with GPTs (greater than 10 cm3 in volume) who were treated surgically with BETS, craniotomy, or MTS from October 1994 to July 2009 were reviewed for clinical outcomes, degree of tumor resection, recurrence rates, and surgical complications.


RESULTS
The BETS group had significantly better mean reduction of tumor volume (91%) than the craniotomy (63%, p = 0.001), and the MTS (63%, p = 0.010) groups. Gross total resection rates were also higher for BETS patients than for craniotomy patients (p = 0.010). Improvements in vision and headaches were noted in 96% and 100% of patients in the BETS group, respectively; these rates were similar to those in the craniotomy and MTS groups. Of the four patients with hormone-secreting tumours in the BETS group, three remained in remission. The median length-of-stay (four days) for the BETS group was shorter (p = 0.010), and surgical complications were less frequent (p = 0.037) and less severe compared to the craniotomy group. There were no differences in the recurrence rates: 79% percent of patients in the BETS group, 69% in the craniotomy group, and 79% in the MTS group were recurrence free at last follow-up (p = 0.829).


CONCLUSIONS
Treatment of GPT with BETS offers excellent oncologic and clinical outcomes and can frequently obviate the need for craniotomy in these patients.
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada. injuryprevention@smh.ca
Michael D
MD
Cusimano
Peter
P
Kan
Farshad
F
Nassiri
Jennifer
J
Anderson
Jeannette
J
Goguen
Irene
I
Vanek
Harley S
HS
Smyth
Ronald
R
Fenton
Paul J
PJ
Muller
Kalman
K
Kovacs
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018286:Carcinoma, Giant Cell / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden; D055815:Young Adult