Hurdle of giant pituitary adenoma in achieving total resection

Background: Giant pituitary adenoma is a challenging disease in the neurosurgical field. Several therapeutic strategies have been performed depending on tumor characteristics and the surgeon’s experience during the last decades, but it is still difficult to achieve the gross total resection with good clinical outcome. Here, we present our clinical experience with giant pituitary adenomas (PAs) focusing on factors related to surgical outcome. Materials and Methods: A total of 26 patients with giant PAs were collected. All clinical data, including preoperative symptom, visual and hormonal function, operation record, and radiologic imaging, were reviewed. Statistical analysis was used to identify the factors related with the extent of resection. Results: The median age of patients was 53 years, and all patients showed impaired vision. Endo-scopic transsphenoidal surgery, staged operation, and open craniotomy were performed in 19, 5, and 2 patients, respectively. Fifteen patients received gross total resection, 14 patients received subtotal resection and 1 patient received partial resection. Postoperatively, visual function was improved in 14 patients, not changed in 6, and deteriorated in 4. Gross total resection was significantly related with the tumor size (45 mm), Knosp grade, ICA (internal carotid artery) encasement, and middle cranial fossa extension in the statistical analysis. Conclusions: Despite of the limited experience for giant PAs, it still hard to achieve the gross total resection and good clinical outcome. We recommend identifying the tumor characteristics that make it difficult to complete total resection before surgery and consider other strategies, such as staged op-eration or adjuvant radiotherapy.