Surgical considerations in the endoscopic endonasal transphenoidal approach for giant pituitary adenomas: A single surgeons' experience over a decade

Aim: To determine the significance of patient demographics; presenting symptoms and examination findings; pre-operative hormonal status; tumor characteristics and postoperative extent of resection on outcome in all patients whom underwent an endoscopic endonasal transphenoidal resection of a giant pituitary adenoma. Methods: From 01 January 2005–31 December 2016 sixty-two patients with giant pituitary adenomas were operated by a single surgeon via an endoscopic endonasal transphenoidal approach in our Department. We performed a retrospective chart review of these cases specifically recording patient age; gender; presenting Glasgow coma score and visual acuity; tumor size specifically recording height, width and anteroposterior measurements; whether complete/partial resection was achieved; post-operative cerebrospinal fluid leak and presence of diabetes insipidus; and Glasgow Outcome Score (GOS)at discharge. Results: Of the variables considered significance was demonstrated between the pre-operative examination finding of absence of perception of light and GOS (p = 0.002). Significance was also demonstrated with regards pre-operative tumor size measured in any of the three dimensions namely tumor height (p = 0.03), tumor width (p = 0.01)and especially the pre-operative tumoral antero-posterior measurement (p = 0.006). None of the other variables considered demonstrated significance in terms of outcome. Conclusion: The pre-operative examination finding of no perception of light and the diagnosis of a giant pituitary adenoma measured in any dimension but especially antero-posteriorally are specific prognostic variables that demonstrate significance in predicting outcome in patients with giant pituitary adenomas being considered for the endoscopic endonasal transphenoidal approach.