Clinical presentation and surgical outcomes of very large and giant pituitary adenomas: 80 cases in a cohort study of 306 patients with pituitary adenomas

Purpose To identify differences in the presentation and surgical outcomes between very large (30–39 mm) and giant (≥ 40 mm) (LARGE group) pituitary adenomas (PAs) compared to the smaller group (< 30 mm) (non-LARGE group). Methods Eighty patients with very large ( n = 44) or giant ( n = 36) PAs...

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Published in:	Acta neurochirurgica Vol. 166; no. 1; p. 225
Main Authors:	Pascual-Corrales, Eider, Acitores Cancela, Alberto, Baonza, Gonzalo, Madrid Egusquiza, Imanol, Rodríguez Berrocal, Víctor, Araujo-Castro, Marta
Format:	Journal Article
Language:	English
Published:	Vienna Springer Vienna 21-05-2024 Springer Nature B.V
Subjects:	Adenoma Adenoma - diagnostic imaging Adenoma - pathology Adenoma - surgery Adult Aged Cohort Studies Complications Female Humans Hypopituitarism - etiology Interventional Radiology Male Medicine Medicine & Public Health Middle Aged Minimally Invasive Surgery Neurology Neuroradiology Neurosurgery Original Article Patients Pituitaries Pituitary Pituitary Neoplasms - diagnostic imaging Pituitary Neoplasms - pathology Pituitary Neoplasms - surgery Postoperative Postoperative Complications - epidemiology Postoperative Complications - etiology Retrospective Studies Surgical Orthopedics Surgical outcomes Treatment Outcome Tumor Burden Tumors Vision Disorders - etiology Visual impairment Surgical remission Transsphenoidal surgery Pituitary tumors Pituitary adenoma Giant pituitary adenomas
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Summary:	Purpose To identify differences in the presentation and surgical outcomes between very large (30–39 mm) and giant (≥ 40 mm) (LARGE group) pituitary adenomas (PAs) compared to the smaller group (< 30 mm) (non-LARGE group). Methods Eighty patients with very large ( n = 44) or giant ( n = 36) PAs and 226 patients in the non-LARGE group who underwent tumor resection by pituitary surgery between 2008 and 2023 were studied. Hormonal, radiological, ophthalmological, and pathological data, and surgical outcomes were evaluated. Results Preoperatively, patients of the LARGE group presented more frequently with visual impairment (82.5% vs. 22.1%, P < 0.001) and with pituitary apoplexy (15.0% vs. 2.7%, P < 0.001) than the non-LARGE group. Moreover, the LARGE group were more commonly associated with preoperative panhypopituitarism (28.8% vs. 6.2%, P < 0.001). This group presented cavernous sinus invasion more frequently (71.3% vs. 23.9%, P < 0.001). The non-LARGE group achieved surgical cure more often than the LARGE group (79.7% vs. 50.0%, P < 0.001), and the rate of major complications was higher in the latest (8.8% vs. 1.3%, P < 0.004). Conclusions PAs ≥ 30 mm are most frequently accompanied by hormonal dysfunction, cavernous sinus invasion, and visual impairment. All this implies lower resection rates and higher postoperative complications than the smaller adenomas, posing a real surgical challenge.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0942-0940 0001-6268 0942-0940
DOI:	10.1007/s00701-024-06107-w