Endoscopic endonasal resection of giant pituitary adenomas - case series from the referral pituitary center.

PURPOSE: The giant pituitary adenomas (GPAs) are still a challenging surgical problem. They comprise 10-15% of operated pituitary adenomas. The advances of endoscopic techniques allow the resection of pituitary tumors previously operated by transcranial approaches. The aim of the study was to review the surgical results in a series of patients with GPAs (diameter ≥ 40 mm) operated with endoscopic endonasal approach. METHODS: The study is a retrospective analysis of a series of 176 patients (66 women and 110 men) treated from the 2007 to 2023 by the endoscopic transsphenoidal surgeries for GPAs (> 40 mm). The mean age of the patients was 57.0 years (20-81 years), and the mean follow-up period was 7.5 years (0-16 years). Forty patients had 1a grade of the Lyon's clinicopathologic classification, 7 patients - 1b, 111 patients - 2a, and 18 patients - 2b. RESULTS: The gross total resection was accomplished in 73 cases (41.5%). Extended endoscopic approaches were used in 11 patients (6.3%). The mortality rate was 2.3%. Postoperatively 60% of the patients showed varying improvement in visual field defects and visual acuity. The morbidity rate was 33.5%. During a mean 7.5 years follow-up there were 29 (15.9%) cases of recurrences. CONCLUSION: Our results indicate that resection with endoscopic endonasal approach can be a safe and effective method for the treatment of patients with GPAs. It is the alternative for transcranial approaches.