Neurosurgical Treatment of Giant Pituitary Adenoma

ABSTRACT

In order to establish a more reasonable therapeutic guide line for giant pituitary adenomas, the authors analyzed 31 cases of giant pituitary adenoma which were operated on between January, 1985 and July, 1987. The term, 'giant' applies primarily to a pituitary adenoma with a size of 4 cm or more in diameter. The two most common chief complaints were visual disturbance(18 cases) and headache(6 cases). Endocrinoloically, 17 cases(55%) were non-functioning and 14 cases(45%) produced hypersecretion syndromeprolactionoma(8 cases), acromegaly(5 cases), and Nelson's syndrome(1 case). Twenty-eight cases showed marked suprasellar extension. Surgical treatment was given to 16 cases by transphenoidal approach and 15 cases by transcranial approach. Postoperative radiation therapy was given to 22 cases. Surgical results in the transsphenoidal group were better than in the transcranial group as there were fewer and less severe postoperative complications without a deterioration of vision. For the treatment of the giant pituitary adenoma, decompression of the tumor through transsphenoidal approach at first followed by postoperative radiation therapy, was effective. The transcranial approach was considered to be recommendable in cases of recurrence.