{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,14]],"date-time":"2026-11-14T16:32:53Z","timestamp":1794673973896,"version":"4.9.1"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Given the anatomical complexity and frequently invasive growth of giant pituitary adenomas (GPAs), individually tailored approaches are required. The aim of this study was to assess the treatment strategies and outcomes in a large multicenter series of GPAs in the era of endoscopic transsphenoidal surgery (ETS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      This was a retrospective case-control series of 64 patients with GPAs treated at two tertiary care centers by surgeons with experience in ETS. GPAs were defined by a maximum diameter of \u2265 4 cm and a volume of \u2265 10 cm\n                      <jats:sup>3<\/jats:sup>\n                      on preoperative isovoxel contrast-enhanced MRI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The primary operation was ETS in all cases. Overall gross-total resection rates were 64% in round GPAs, 46% in dumbbell-shaped GPAs, and 8% in multilobular GPAs (p &lt; 0.001). Postoperative outcomes were further stratified into two groups based on extent of resection: group A (gross-total resection or partial resection with intracavernous remnant; 21\/64, 33%) and group B (partial resection with intracranial remnant; 43\/64, 67%). Growth patterns of GPAs were mostly round (11\/14, 79%) in group A and multilobular (33\/37, 89%) in group B. In group A, no patients required a second operation, and 2\/21 (9%) were treated with adjuvant radiosurgery. In group B, early transcranial reoperation was required in 6\/43 (14%) cases due to hemorrhagic transformation of remnants. For the remaining group B patients with remnants, 5\/43 (12%) underwent transcranial surgery and 12\/43 (28%) underwent delayed second ETS. There were no deaths in this series. Severe complications included stroke (6%), meningitis (6%), hydrocephalus requiring shunting (6%), and loss or distinct worsening of vision (3%). At follow-up (mean 3 years, range 0.5\u201316 years), stable disease was achieved in 91% of cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>ETS as a primary treatment modality to relieve mass effect in GPAs and extent of resection are dependent on GPA morphology. The pattern of residual pituitary adenoma guides further treatment strategies, including early transcranial reoperation, delayed endoscopic transsphenoidal\/transcranial reoperation, and adjuvant radiosurgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2021.1.jns203982","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T13:49:11Z","timestamp":1629467351000},"page":"776-785","source":"Crossref","is-referenced-by-count":38,"title":["Treatment strategies for giant pituitary adenomas in the era of endoscopic transsphenoidal surgery: a multicenter series"],"prefix":"10.3171","volume":"136","author":[{"given":"Alexander","family":"Micko","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California;"},{"name":"Department of Neurosurgery, Medical University of Vienna, Austria; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew S.","family":"Agam","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Brunswick","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben A.","family":"Strickland","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J.","family":"Rutkowski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Departments of Endocrinology and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark S.","family":"Shiroishi","sequence":"additional","affiliation":[{"name":"Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Engelbert","family":"Knosp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Vienna, Austria; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Wolfsberger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical University of Vienna, Austria; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"r1","series-title":"Neurosurgery","first-page":"993","article-title":"Surgical treatment of giant pituitary adenomas: strategies and results in a series of 95 consecutive patients","volume":"60","author":"Mortini P","year":"2007","unstructured":"Mortini P, Barzaghi R, Losa M,  Surgical treatment of giant pituitary adenomas: strategies and results in a series of 95 consecutive patients. 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