Giant Pituitary Tumors: Surgical Outcomes and Management
Introduction
Giant pituitary tumors (>40 mm) present a major therapeutic challenge due to the lack of established guidelines. This retrospective study analyzes a large cohort of patients managed by an expert multidisciplinary team, focusing on treatments and postoperative outcomes.
Methods
• Retrospective study on giant pituitary tumors (>40 mm).
• Exclusion of macroprolactinomas responsive to dopamine agonists.
• Surgery performed by a single team, mainly via endoscopic endonasal approach.
• Follow-up included hormone replacement therapy, radiotherapy, and anti-tumor medical treatments.
Results
• 63 patients included, most presenting with visual impairments.
• Surgical interventions: 59% operated once, 40% twice, 1% three times.
• Tumor types: Gonadotroph (67%), corticotroph (14%), somatotroph (11%), lactotroph (6%), mixed GH-PRL (2%).
• Visual improvement in 89% of patients with preoperative visual deficits.
• Severe surgical complications in 11% of cases, mostly for tumors >50 mm requiring a transcranial microscopic approach.
• Additional treatments:
• Radiotherapy required for 29% of patients (3 to 56 months after surgery).
• Temozolomide treatment needed for 6% of patients (19 to 66 months after surgery).
Conclusion
Giant pituitary tumors require a multimodal management approach where surgery plays a central role. Expert multidisciplinary care allows for better tumor control and significant clinical improvement.
