title: Transcranial approach in giant pituitary adenomas: results and outcome in a modern series.
abstract: BACKGROUND
  Today, transcranial (TC) approach indications are particularly rare in pituitary adenomas (PA), representing 1.1% of all PA surgeries in our experience. In these rare and selected cases, the complications, advantages, and disadvantages of TC approach were also analyzed.
  
  
  METHODS
  Nineteen cases of giant PA (≥40 mm) operated via TC approach alone or combined with transsphenoidal (TS) approach between 2000 and 2016 were selected.
  
  
  RESULTS
  The most frequently observed symptom was visual disturbance. Most PA (79%) were non-secreting. Only one tumor was aggressive. Maximal diameter average was 51.5 mm. Tumor removal was total, subtotal and partial in respectively 21%, 68.5%, and 10.5% of cases. Mean follow-up was 57 months. No recurrence was observed after total tumor removal. Visual improvement was observed in 53% of patients. Visual impairment rate was 21% after TC approach. New cases of panhypopituitarism were reported in 26.5% of patients in the TC approach. Total (including definitive and transient) postoperative diabetes insipidus occurred in 42% of patients in the TC approach. Ischemic and hemorrhagic complications were observed in 16% and 10.5% of patients, respectively, in the TC approach. Preoperative neurocognitive disturbance was identified in 31.5% of patients and only 16.5% of them showed postoperative improvement. Neurocognitive examination showed impaired results in 7.5% of patients with normal preoperative examination.
  
  
  CONCLUSIONS
  TC approach remains a requirement in giant and invasive PAs non-accessible via TS approach. However, the high morbidity associated with TC approach, including ischemic complications and visual impairment, has to be balanced with patient preoperative symptoms, and benign features of the tumor.
authors.affiliation: Department of Neurosurgery, La Timone Hospital, Marseilles, France - Thomas.Graillon@ap-hm.fr.|Aix-Marseille University, Marseilles, France - Thomas.Graillon@ap-hm.fr.
authors.forename: Thomas
authors.initials: T
authors.lastname: Graillon
authors.affiliation: Department of Endocrinology, La Conception Hospital, Marseilles, France.|Aix-Marseille University, Marseilles, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Castinetti
authors.affiliation: Department of Neurosurgery, La Timone Hospital, Marseilles, France.|Aix-Marseille University, Marseilles, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Fuentes
authors.affiliation: Department of Neurosurgery, La Timone Hospital, Marseilles, France.|Aix-Marseille University, Marseilles, France.
authors.forename: Regis
authors.initials: R
authors.lastname: Gras
authors.affiliation: Department of Endocrinology, La Conception Hospital, Marseilles, France.|Aix-Marseille University, Marseilles, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Brue
authors.affiliation: Department of Neurosurgery, La Timone Hospital, Marseilles, France.|Aix-Marseille University, Marseilles, France.
authors.forename: Henry
authors.initials: H
authors.lastname: Dufour
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D010911:Pituitary Neoplasms / Q000601:surgery*; D016896:Treatment Outcome