Giant pituitary adenomas: efficacy, complications, and predictors of surgical outcome with endoscopic endonasal surgery

Abstract

Background and objectives
Giant pituitary adenomas (GPAs) are challenging due to their size and proximity to vital neurovascular structures. While the endoscopic endonasal transsphenoidal approach (EETA) is increasingly used for pituitary adenoma resection, its effectiveness for giant adenomas remains underexplored. This study assesses EETA outcomes for GPA resection at a tertiary care center, focusing on resection extent, complications, and factors affecting surgical outcome.


Methods
This retrospective study reviewed the clinical data of 50 patients who underwent EETA for giant pituitary adenomas at our institution between 2018 and 2025. Demographic data, tumour characteristics, surgical outcomes, extent of resection, and postoperative complications were analysed. Factors such as tumour size, invasion of surrounding structures, and preoperative visual and endocrine status were evaluated to identify predictors of surgical outcome.


Results
The study included 50 patients with mean age of 40.92 years with a male preponderance in the cohort of 60%. The mean tumour dimensions were 41 mm(craniocaudal) × 43 mm(mediolateral) × 39(anteroposterior) mm The gross total resection (GTR) rate was achieved in 64% of cases, near total in 32% and subtotal resection in 4%. Postoperative complications were observed in 34% of the patients, with the most common being transient diabetes insipidus in 30%. Improvements in visual function was noted in 62% of patients postoperatively.


Conclusion
Endoscopic endonasal surgery is a safe and effective approach for GPAs, offering favourable visual and functional outcomes with manageable complication rates.