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This study aimed to assess treatment strategies of GPAs in a large consecutive and uniformly documented series in a single specialized center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 289 patients with GPA who underwent primary surgery in our department between December 1982 and December 2022 were analyzed in this retrospective study. GPAs were defined by a maximum diameter of\u2009\u2265\u20094\u00a0cm in at least one plane. Patients were reviewed for endocrine, radiological and ophthalmological outcomes as well as complication and mortality rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean maximum tumor diameter was 4.6\u2009\u00b1\u20090.7 cm. 201 patients (69.6%) underwent transsphenoidal and 36 patients (12.4%) underwent transcranial surgery only. 52 patients (18.0%) underwent a combined approach within a few weeks. Gross-total resection (GTR) was achieved in one-fifth (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200952) of the patients. It was dependent, among other factors, on patients\u2019 tumor size and tumor extension. Severe complications such as tumor apoplexy, meningitis or cerebrospinal fluid leaks occurred in 5.9%, 3.5% and 2.8% of patients, respectively. Seven deaths (2.4%) occurred in the early postoperative period. The median follow-up time was 76 months, at which point 70.2% of patients showed a stable condition without requiring further treatment.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Generally, the treatment of giant pituitary adenomas remains a significant challenge. Although the transsphenoidal approach achieved good results, tumor size and configuration often required a transcranial approach or a combination of different approaches. It is important to consider individual patient and tumor characteristics when selecting the most appropriate surgical approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00701-026-06830-6","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T16:48:10Z","timestamp":1774457290000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Giant pituitary adenomas: an institutional experience with 289 surgically treated patients"],"prefix":"10.1007","volume":"168","author":[{"given":"Victoria Antonia","family":"Binder","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yining","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia Sandra","family":"Breu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moritz","family":"Repschl\u00e4ger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rudolf","family":"Fahlbusch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Buchfelder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,25]]},"reference":[{"issue":"1","key":"6830_CR1","doi-asserted-by":"publisher","first-page":"42","DOI":"10.4158\/EP09221.OR","volume":"16","author":"S Acharya","year":"2010","unstructured":"Acharya S, Gopal R, Menon P, Bandgar T, Shah N (2010) Giant prolactinoma and effectiveness of medical management. 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