{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T11:33:42Z","timestamp":1792582422989,"version":"4.5.0"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2013,3]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Giant pituitary adenomas (&gt; 4 cm in maximum diameter) represent a significant surgical challenge. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for these tumors. The authors present the results of EES for giant adenomas and analyze the advantages and limitations of this technique.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors retrospectively reviewed the medical files and imaging studies of 54 patients with giant pituitary adenomas who underwent EES and studied the factors affecting surgical outcome.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Preoperative visual impairment was present in 45 patients (83%) and partial or complete pituitary deficiency in 28 cases (52%), and 7 patients (13%) presented with apoplexy. Near-total resection (&gt; 90%) was achieved in 36 patients (66.7%). Vision was improved or normalized in 36 cases (80%) and worsened in 2 cases due to apoplexy of residual tumor. Significant factors that limited the degree of resection were a multilobular configuration of the adenoma (p = 0.002) and extension to the middle fossa (p = 0.045). Cavernous sinus invasion, tumor size, and intraventricular or posterior fossa extension did not influence the surgical outcome. Complications included apoplexy of residual adenoma (3.7%), permanent diabetes insipidus (9.6%), new pituitary insufficiency (16.7%), and CSF leak (16.7%, which was reduced to 7.4% in recent years). Fourteen patients underwent radiation therapy after EES for residual mass or, in a later stage, for recurrence, and 10 with functional pituitary adenomas received medical treatment. During a mean follow-up of 37.9 months (range 1\u2013114 months), 7 patients were reoperated on for tumor recurrence. Three patients were lost to follow-up.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Endoscopic endonasal surgery provides effective initial management of giant pituitary adenomas with favorable results compared with traditional microscopic transsphenoidal and transcranial approaches.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.11.jns121190","type":"journal-article","created":{"date-parts":[[2013,1,4]],"date-time":"2013-01-04T15:02:25Z","timestamp":1357311745000},"page":"621-631","source":"Crossref","is-referenced-by-count":196,"title":["Endoscopic endonasal surgery for giant pituitary adenomas: advantages and limitations"],"prefix":"10.3171","volume":"118","author":[{"given":"Maria","family":"Koutourousiou","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A.","family":"Gardner","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan C.","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Paluzzi","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric W.","family":"Wang","sequence":"additional","affiliation":[{"name":"Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl H.","family":"Snyderman","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns121190","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/S0090-3019(02)00705-X","article-title":"Combined transsphenoidal and pterional craniotomy approach to giant pituitary tumors","volume":"57","author":"Alleyne","year":"2002"},{"key":"b2-jns121190","series-title":"Pituitary","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1007\/s11102-008-0120-8","article-title":"Transcranial surgery for pituitary adenomas","volume":"11","author":"Buchfelder","year":"2008"},{"key":"b3-jns121190","series-title":"Adv Tech Stand Neurosurg","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/978-3-211-72283-1_4","article-title":"Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery","volume":"33","author":"Cappabianca","year":"2008"},{"key":"b4-jns121190","series-title":"Neurosurgery","first-page":"363","article-title":"Pituitary apoplexy: a review","volume":"14","author":"Cardoso","year":"1984"},{"key":"b5-jns121190","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"578","DOI":"10.3171\/2009.2.JNS081026","article-title":"Extended endoscopic endonasal transsphenoidal approach for residual or recurrent craniopharyngiomas. 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