Abstract
Pituitary turnors with large suprasellar extensions are a difficult surgical challenge.
A series of 11 patients with giant pituitary adenomas is reported. Seven men and four
women (mean age 54.1 years). were diagnosed following a mean duration of symptoms
of 60 months, Common presenting symptoms included visual disturbances, headache, personality
changes, and panhypopituitarism. A single patient presented with rapid onset of coma
and oculomotor nerve palsy. Eight patients underwent a transsphenoidal approach, and
three patients underwent a craniotomy as the initial surgical procedure. A total of
16 surgical procedures were performed, resulting in complete or near complete resection
in seven patients, and partial removal in four. Six patients had a good outcome and
one patient in poor condition prior to surgery was unchanged postoperatively. One
patient was worse following surgery, and there were two operative deaths. These tumors
have a consistency and a propensity to adhere to neurovascular structures, making
complete surgical resection difficult. Management should be individualized and should
be based upon the radiographic and clinical features of the tumor. We feel that most
leslons are best approached initially transsphenoidally, unless there is significant
lateral extension. In many patients, aggressive surgery is not indicated and limited
subtotal transsphenoidal resection followed by irradiation is recommended. Surgical
decision making and strategy is discussed in relation to our recent experience with
giant pitnitary adenomas.
