Treatment of giant pituitary adenomas

Pituitary adenomas are third commonest primary intracranial tumors after gliomas and meningiomas. About 15% of adenomas extend beyond 40mm above the planum sphenoidale in any direction and by definition are called as giant adenomas. There is a paucity of information regarding the management of giant adenomas and various authors have reported a high mortality rate in management of these tumors. In our series of 127 cases, 13.8% had giant pituitary adenomas. Majority of them were nonfunctioning. Transsphenoidal surgery was the procedure of choice for most of the patients, whereas transcranial surgery was required in patients with multicompartmental tumors; large dumbbell-shaped tumors with suprasellar extension; large residual tumor/postoperative hematoma; uncertain diagnosis or abandoned transsphenoidal procedure because of distorted anatomy. At the last follow-up, overall visual improvement occurred in 58% of the patients. These tumors represent a difficult group to treat, with a high mortality and morbidity, which is more in patients undergoing transcranial surgery as compared with transsphenoidal surgery. Prolactin estimation and preferably immunohistochemical analysis should be performed in all the patients to diagnose clinically indistinct prolactinomas.