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

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. 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. 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. 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. •Absence of perception of light on pre-operative examination is a significant prognostic variable•Pre-operative tumor antero-posterior measurement, height and width, are significant prognositic variables