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Surgical therapeutic strategy for giant pituitary adenomas

To discuss the methods and experience of surgical treatment for giant pituitary adenomas. A total of 246 giant pituitary adenomas were included from January 2004 to January 2015. Massive resection of giant pituitary adenomas was accomplished in all cases. Photon knife radiotherapy was given postoperatively, with follow-up for over a year. Among the included cases, 173 cases were cured, 57 cases were improved, and 16 cases relapsed. There were 115 cases who had transient profuse urination after surgery. Hypopituitarism occurred in 124 cases, most of which already had hypopituitarism before surgery. Ten cases had postoperative intracranial hemorrhage; 8 cases had intracranial infection; 2 cases had cerebrospinal fluid leakage; 36 cases had transient severe internal milieu disorder; 4 cases died because of intracranial hemorrhage and lung infection. Giant pituitary adenomas should be treated by surgery because of its invasiveness, but we do not advocate a complete removal of the tumor. Intraoperative protection of the pituitary stalk is crucial for preventing postoperative hypopituitarism. Postoperative radiotherapy is an important means to cure and prevent recurrence. Different surgical methods should be adopted according to the growth pattern of giant pituitary adenomas. Transsphenoidal surgery is fit for giant pituitary adenomas which grow within the sphenoid sinus. Transcranial surgery is appropriate for giant pituitary adenomas which grow into the suprasellar and parasellar regions. For those growing within the sphenoid sinus while penetrating diaphragma sellae and growing into the suprasellar and parasellar regions, transcranial surgery should be first performed to remove the portion of tumor in the suprasellar and parasellar regions. This will be followed by staging transsphenoidal surgery to remove the portion of tumor which grows within the sphenoid sinus and in the intrasellar region.

Author(s): Han-Shun Deng, Zhi-Quan Ding, Sheng-fan Zhang, Zhi-Qiang Fa, Qing-Hua Wang