The endoscopic endonasal resection of giant pituitary neuroendocrine tumors - case series from the referral pituitary center.

J. Kunicki*^a (Dr), W. Bonicki^b (Prof), B. Buchalska^c (Ms), M. Maksymowicz^d (Dr)

^a Department of Neurosurgery, The Maria Sklodowska-Curie National Research Institute of Oncology,warsaw, Warsaw, POLAND ; ^b Department of Neurosurgery, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Warsaw, POLAND ; ^c Department od Neurosurgery, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Warsaw, POLAND ; ^d Department of Neurosurgery, The Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Warsaw, POLAND

* jkunickii@gmail.com

Introduction: The Giant PitNets ( adenomas) are still a challenging surgical problem, they comprose from 6-15 % of operated adenomas.The advances of an endoscopic technique allow the resection of pituitary tumors previously operated by transcranial approaches.

The aim of the study was to review the surgical results in a series of patients with giant pituitary adenomas operated with endoscopic endonasal approach.

Material and methods: The study is a retrospective analysis of a series of 122 patients with giant pituitary adenomas operated at the Department of Neurosurgery, Maria Sklodowska-Curie National Research Institute of Oncology,Warsaw, Poland from 2010 to 2021.

Results: The gross total resection was accomplished in 65 out of 122 cases (53.3%), the subtotal resection was achieved in 42 of 122 patients (34.4%), in 9 cases ( 7.3%) only the partial resection was possible. There were no mortalities in the series. Postoperatively 83% of the patients showed varying improvement in visual field defects and visual acuity. Transient diabetes insipidus( DI) was observed in 16 pactiens (13.1%), permanent DI was diagnosed in 5 patients ( 4%). The postoperative CT scan revealed significant intrasellar/supraselar haematoma in 7 patients and 3 of them were reoperated. The CSF leak was observed in 2 cases (1.6%) There was one case of visual function deterioration in the series. During a mean 61 month observation there were 5 (7.6%) cases of recurrences and 12 (23%) cases of residual tumor progression .

Conclusions: Our results indicate that resection with endoscopic endonasal approach can be a safe and effective method for the treatment of patients with giant pituitary adenomas and it is the alternative for transcranial approaches.

The author has declared no conflict of interest.