Surgical Results of Large and Giant Pituitary Adenomas with Special Consideration of Ophthalmologic Outcomes

• Published in: World neurosurgery 2011-07, Vol.76 (1), p.141-148
• Main Authors: Müslüman, Ahmet Murat, Cansever, Tufan, Yılmaz, Adem, Kanat, Ayhan, Oba, Ersin, Çavuşoğlu, Halit, Şirinoğlu, Deniz, Aydın, Yunus
• Format: Article
• Language: English
• Subjects: Adenoma - mortality; Adenoma - pathology; Adenoma - physiopathology; Adenoma - surgery; Adenomas; Adult; Aged; Biological and medical sciences; Cavernous Sinus - pathology; Chemotherapy, Adjuvant; Craniotomy; Female; Follow-Up Studies; Fundus Oculi; Giant; Humans; Large; Male; Medical sciences; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Neurosurgery; Neurosurgical Procedures - methods; Ophthalmologic; Outcomes; Pituitary; Pituitary Hormones - blood; Pituitary Neoplasms - mortality; Pituitary Neoplasms - pathology; Pituitary Neoplasms - physiopathology; Pituitary Neoplasms - surgery; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Sphenoid Bone - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Vision Disorders - epidemiology; Vision Disorders - etiology; Vision Disorders - physiopathology; Vision Tests; Visual Acuity; Visual Field Tests; Visual Fields; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2011.02.009

Objective To analyze functioning and nonfunctioning pituitary adenomas (PAs) >3 cm, with special emphasis on preoperative and postoperative visual functions. Methods The cases consisted of 49 women and 54 men with mean age of 43.2 years (range 19–66 years). All cases had a macroadenoma >3 cm in diameter. The transsphenoidal approach was performed in 117 procedures, and the transcranial approach was performed in 8 procedures. Radical tumor excision was achieved in 50 of 103 patients. Postoperative evaluation was done in 88 patients. Preoperative and postoperative visual acuity, visual field, and ocular fundi and their relationship with the pattern and duration of the symptoms and the size of the tumor were evaluated. Results Normalization of visual acuity was obtained in 71.5% of patients, improvement occurred in 13.6%, symptoms persisted in 13.6%, and symptoms worsened in 1%. Postoperative improvement of visual field defects (VFDs) was observed in 74.1% of patients, and visual impairment score improved postoperatively in 92% of patients. Patients operated on