Transcranial Microsurgery as a Salvage Strategy in Giant Pituitary Adenomas: A Single-Center Experience and Long-Term Follow-up Results.

Abstract

Introduction: Endoscopic transsphenoidal surgery (ETSS) is the preferred approach for most pituitary adenomas. However, transcranial microsurgery remains relevant for giant adenomas with complex features. This study presents long-term outcomes and complications in a single-surgeon series of patients with giant pituitary adenomas who underwent transcranial resection.

Material and methods: This retrospective study analyzed 29 patients with giant pituitary adenomas (≥4 cm) who underwent transcranial surgery between 2009 and 2018 at Bursa Uludağ University Faculty of Medicine. Inclusion criteria were: a minimum tumor diameter of 4 cm, histologically confirmed pituitary adenoma, tumor resection via a transcranial approach, regular postoperative follow-up, and a minimum follow-up of 60 months. Data collected included patient demographics, clinical presentation, tumor characteristics, surgical details, extent of resection, and long-term outcomes (minimum 60 months follow-up).

Results: The mean patient age was 48.17 ± 12.92 years. Vision loss was the most common presenting symptom (n = 20). Gross total resection (GTR) was achieved in 51.7% (n = 15) and subtotal resection (STR) in 48.3% (n = 14). Postoperative improvement in visual function was observed in 48.3% (n = 14), while 20.7% (n = 6) experienced deterioration. Endocrinological remission occurred in 20.7% (n = 6). Complications included diabetes insipidus (24.13%, n = 7), cerebrovascular events (10.34%, n = 3), and mortality (17.24%, n = 5).

Conclusions: Transcranial surgery for giant pituitary adenomas can achieve favorable outcomes in terms of tumor control and visual function improvement. However, it is associated with a risk of complications, including endocrinological and cerebrovascular events. Careful patient selection, meticulous surgical technique, and close postoperative monitoring are essential for optimizing outcomes. Transcranial microsurgery remains an important tool in the armamentarium of neurosurgeons managing complex giant pituitary adenomas.