Giant Pituitary Adenoma - Special Considerations

Oliver Y Tang; Wayne D Hsueh; Jean Anderson Eloy; James K Liu

doi:10.1016/j.otc.2021.12.008

Giant Pituitary Adenoma - Special Considerations

Otolaryngol Clin North Am. 2022 Apr;55(2):351-379. doi: 10.1016/j.otc.2021.12.008.

Authors

Oliver Y Tang¹, Wayne D Hsueh², Jean Anderson Eloy³, James K Liu⁴

Affiliations

¹ Department of Neurosurgery, Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA. Electronic address: https://twitter.com/@oliverytang.
² Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen Street Room, Suite 8100, Newark, NJ 07101, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, 90 Bergen Street Room, Suite 8100, Newark, NJ 07101, USA.
³ Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen Street Room, Suite 8100, Newark, NJ 07101, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, 90 Bergen Street Room, Suite 8100, Newark, NJ 07101, USA; Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, NJ, USA.
⁴ Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, 90 Bergen Street Room, Suite 8100, Newark, NJ 07101, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, 90 Bergen Street Room, Suite 8100, Newark, NJ 07101, USA; Saint Barnabas Medical Center, RWJ Barnabas Health, Livingston, NJ, USA. Electronic address: james.liu.md@rutgers.edu.

PMID: 35365313
DOI: 10.1016/j.otc.2021.12.008

Abstract

Giant pituitary adenomas (GPAs) comprise 5% to 15% of pituitary adenomas, but have higher rates of extrasellar invasion, subtotal resection, surgical morbidity, and recurrence. With the possible exception of giant prolactinomas, GPAs require surgical decompression. On review of 3 decades of case series encompassing 699 microsurgical transsphenoidal (MT), 1060 endoscopic endonasal trans-sphenoidal (EET), and 513 transcranial (TC) patients, gross total resection and recurrence rates were comparable across modalities, but the EET approach had lower perioperative mortality and superior restoration of visual function. Each approach has unique indications. Combined EET-TC approaches for minimizing residual tumor represent another area of study.

Keywords: Endoscopic endonasal surgery; Microsurgery; Neurosurgery; Pituitary adenoma; Skull base; Transsphenoidal surgery; Tumor; Tumor outcomes.

Publication types

Review

MeSH terms

Adenoma* / surgery
Endoscopy
Humans
Pituitary Neoplasms* / pathology
Pituitary Neoplasms* / surgery
Retrospective Studies
Treatment Outcome