{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T11:13:31Z","timestamp":1793272411712,"version":"4.5.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Giant pituitary adenomas (GPA) pose a significant neurosurgical challenge. In this study, we present an experience of 60 consecutive patients with GPA operated by trans-sphenoidal surgery (microscopic\/endoscopic).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The aim of this study was to elucidate preoperative factors predicting extent of resection (EOR) following transsphenoidal surgery for GPA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>The study was a retrospective evaluation of 60 adult patients (&gt;18 years) with GPA operated over a decade. The patients were analyzed for their clinical presentation, EOR, radiology, visual outcome, endocrinological outcome, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean age of the cohort was 41.5 \u00b1 13.3 years, mean tumor volume was 38.2 \u00b1 19.1 cm\n                      <jats:sup>3<\/jats:sup>\n                      , and mean follow-up was 30.6 \u00b1 21.7 months. Improvement in vision was seen in forty patients (66.7%), while another 16 (26.7%) had stable vision as prior to surgery. Duration of visual symptoms was found to be statistically significantly associated with postoperative improvement of vision (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001). Twenty-four patients (40.0%) underwent subtotal resection (STR), while the remaining 36 patients (60.0%) underwent either gross total or near-total resection. Factors associated with STR were retrosellar (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.04), subfrontal (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.02), Knosp 3,4 cavernous sinus extension (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.03), and MRI T2 hypointensity (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.02). During follow-up, eight patients (13.3%) had radiological evidence of growth of residual tumor.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Most cases of GPA can be adequately handled by trans-sphenoidal surgery. The presence of retrosellar, subfrontal, cavernous sinus extensions, and T2 hypointensity should alert the surgeon for likelihood of STR, postoperative residual tumor hemorrhage and need for second-stage endonasal or transcranial surgery. However, utilization of extended endoscopic route has allowed good debulking of tumors having subfrontal and parasellar extensions, which was not possible previously using traditional microscopic transsphenoidal surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/0028-3886.388120","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T07:01:15Z","timestamp":1697612475000},"page":"907-915","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Role of Cavernous Sinus Extension and MRI T2 Hypointensity in the Extent of Resection following Trans-Sphenoidal Surgery for Giant Pituitary Adenomas"],"prefix":"10.4103","volume":"71","author":[{"given":"Raghav","family":"Singla","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Suri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-9-20240907","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1136\/jnnp.42.2.123","article-title":"Transcranial management of pituitary tumours with suprasellar extension","volume":"42","author":"Symon","year":"1979","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"R2-9-20240907","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1017\/S0317167100013950","article-title":"Outcomes of surgically treated giant pituitary tumours","volume":"39","author":"Cusimano","year":"2012","journal-title":"Can J Neurol Sci J Can Sci Neurol"},{"key":"R3-9-20240907","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1007\/s11102-011-0350-z","article-title":"Volumetric classification of pituitary macroadenomas predicts outcome and morbidity following endoscopic endonasal transsphenoidal surgery","volume":"15","author":"Hofstetter","year":"2012","journal-title":"Pituitary"},{"key":"R4-9-20240907","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.surneu.2003.08.036","article-title":"Giant pituitary tumors: A study based on surgical treatment of 118 cases","volume":"61","author":"Goel","year":"2004","journal-title":"Surg Neurol"},{"key":"R5-9-20240907","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1111\/j.1365-2265.2009.03665.x","article-title":"Endonasal transsphenoidal surgery and multimodality treatment for giant pituitary adenomas","volume":"72","author":"de Paiva Neto","year":"2010","journal-title":"Clin Endocrinol Oxf"},{"key":"R6-9-20240907","doi-asserted-by":"crossref","first-page":"e281","DOI":"10.1016\/j.wneu.2013.08.028","article-title":"Giant pituitary adenomas: Surgical outcomes of 50 cases operated on by the endonasal endoscopic approach","volume":"82","author":"Gondim","year":"2014","journal-title":"World Neurosurg"},{"key":"R7-9-20240907","doi-asserted-by":"crossref","first-page":"75","DOI":"10.3171\/2014.3.JNS131679","article-title":"Endoscopic endonasal transsphenoidal approach to large and giant pituitary adenomas: Institutional experience and predictors of extent of resection","volume":"121","author":"Juraschka","year":"2014","journal-title":"J Neurosurg"},{"key":"R8-9-20240907","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jocn.2017.07.015","article-title":"Large and giant pituitary adenoma resection by microscopic trans-sphenoidal surgery: Surgical outcomes and complications in 123 consecutive patients","volume":"44","author":"Karki","year":"2017","journal-title":"J Clin Neurosci"},{"key":"R9-9-20240907","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3109\/02688690903370305","article-title":"Giant pituitary adenomas--An enigma revisited. 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