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Surgical Management of Giant Pituitary Adenomas

Published online by Cambridge University Press:  18 September 2015

Gérard Mohr ,
Jules Hardy ,
Ronald Comtois  and
Hughes Beauregard
Gérard Mohr
Affiliation:
divisions of Neurosurgery and Endocrinology, Notre-Dame Hospital, University of Montreal, Montreal
Jules Hardy*
Affiliation:
divisions of Neurosurgery and Endocrinology, Notre-Dame Hospital, University of Montreal, Montreal
Ronald Comtois
Affiliation:
divisions of Neurosurgery and Endocrinology, Notre-Dame Hospital, University of Montreal, Montreal
Hughes Beauregard
Affiliation:
divisions of Neurosurgery and Endocrinology, Notre-Dame Hospital, University of Montreal, Montreal
*
service de Neurochirurgie, Hôpital Notre-Dame, 1560 est rue Sherbrooke, Montréal, Québec, Canada H2L 1M4
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Abstract:

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During the past 25 years, 77 giant pituitary adenomas have been treated surgically, including suprasellar extensions of type C in 66 cases and of type D in 11 cases. Non-secreting adenomas were present in 53 and secreting adenomas in 24 cases. All patients except 3 presented with significant visual field defects; including bitemporal hemianopia, superior quadranopia or unilateral temporal hemianopia, contralateral blindness in 73% of the cases, and one case with sudden bilateral blindness due to acute pituitary apoplexy. A single transsphenoidal procedure was carried out in 74% of the patients while 11 patients (7%) required re-operations for recurrent or residual tumor. Only 3 patients required a subsequent transcranial procedure. Complications included 1 CSF-leak, 1 empty-sella syndrome and 4 fatal post-operative hematomas. We prefer the transsphenoidal route even in very large or giant pituitary adenomas, since it allows rapid and adequate decompression of the optic nerves and chiasm, avoids major pituitary insufficiency in 60% of the cases and is associated with low morbidity-mortality rates.

Type
Special Supplement - Secreting Pituitary Adenomas
Information
Canadian Journal of Neurological Sciences , Volume 17 , Issue 1 , February 1990 , pp. 62 - 66
Copyright
Copyright © Canadian Neurological Sciences Federation 1990

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