Giant Pituitary Tumors : A Study based on the Surgical Treatment of 180 Cases

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Background : The aim of the study is to analyze the nature, extensions and dural relationships of hormonally inactive giant pituitary tumors. The relevance of the anatomical relationships to surgery is analyzed. Method : One hundred eighty cases of hormonally inactive pituitary tumors with a maximum dimension of more than 4 cm were analyzed. These cases were surgically treated in our neurosurgical department from 1995 to August 2004. The anatomical extension of these tumors was studied on the basis of radiological features and surgical observations. Depending on the extensions and the nature of their meningeal coverings these tumors were divided into four grades. The grades reflected an increasing order of invasiveness of adjacent dural and arachnoidal compartments. The strategy and outcome of surgery and radiotherapy is analyzed for these four groups. Average duration of follow-up was thirty-six months. Results : There were 80 giant pituitary tumors, which remained within the confines of the sellar dura and under the diaphragma sellae and did not enter into the compartment of the cavernous sinus (Grade I ). Transgression of the medial wall and invasion into the compartment of the cavernous sinus (Grade II) was seen in 57 cases. Elevation of the dura of the superior wall of the cavernous sinus and extension of this elevation into various compartments of brain (Grade III) was observed in 37 cases. Supradiaphragmatic-subarachnoid extension (Grade IV) was seen in 6 patients. The majority of patients were treated by transsphenoidal route. Conclusions : Giant pituitary tumors usually have a meningeal cover and extend into well-defined anatomical pathways. Radical surgery by the transsphenoidal route is indicated and possible in Grade I -III pituitary tumors. Such a strategy offered a reasonable opportunity for recovery in vision and a satisfactory post-operative and long-term outcome. Biopsy of the tumor followed by radiotherapy could be suitable for GradelV pituitary tumors.

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