الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Pituitary adenomas are benign neoplasms that represent 10 to 20% of all intracranial lesions, They are classified according to tumor size and to secretory status. Giant pituitary adenomas are those who are more than 4 cm in maximum diameter.
Surgical resection is the first line of management for symptomatic non-functioning GPA. The transsphenoidal midline route represents the standard approach. Purely endoscopic endonasal approach has evolved in the last two decades and is now considered the gold standard surgical approach for management of these tumors.
Further refinements of the technique by many endoscopic skull base centers, the endoscopic endonasal technique has continuously evolved, extending gross total resection to pituitary adenomas that previously would have been considered only for surgical debulking, transcranial approaches and adjuvant radiotherapy. The introduction of truly ‘extended endonasal’ approach has enabled the pituitary surgeon to safely achieve a more radical resection.
Patients and methods
This is a prospective observational study conducted at Ain Shams University hospitals, Cairo, Egypt and Weil Cornell
Medical College, Presbyterian hospital. New York, USA from May 2015 to January 2019.
44 patients were enrolled in this study, we prospectively observed the preoperative medical history, imaging studies, visual assessment tests and laboratory investigations.
Purely endoscopic endonasal approach was used as the primary surgical approach for all the patients. Extended endonasal approach was planned in some cases. Method of reconstruction after surgery varied depending on the approach used and the incidence of intraoperative CSF leak.
Postoperative assessment of resection rate, clinical outcome and correlation with different tumor parameters, duration of symptoms and other factors was done.
Postoperative assessment of different complications related to surgery as well as follow up of tumor control and tumor progression, recurrence rate and adjuvant radiotherapy was also done.
Results
The mean age was 53.03 (range 15-82.4) years. Visual affection was present preoperatively in 75% of patients. Preoperative endocrine evaluation revealed partial pituitary deficiency in 14 patients (31.81%), pan-hypopituitarism in six patients (13.64%).
Standard trans-sellar approach was performed in all cases, extended trans-planum approach in 32 (72.7%) patients,
Summary
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and trans-clival approach in 7 (15.9%) patients. Adjuvant radiotherapy as a part of the initial management plan was applied in 2 (4.55%) patients.
Post-operatively vision was improved or normalized in 75.76% of patients, stablized in 21.2%, and only one case developed transient deterioration of vision after surgery. Recovery of pituitary deficiency occurred in five patients (32%) and a new hormonal deficit occurred in five patients. Cerebrospinal fluid leaks occurred in three patients. Permanent diabetes insipidus (DI) occurred in 4 patients.
Gross total resection (GTR) was achieved in 20 (45.45%) patients and subtotal or partial resection in 24 (54.55%) patients. Significant factors that limited the degree of resection were knosp score (P value= 0.04). In a mean follow-up period of 13.66 months, one patient had tumor recurrence and 7 patients had tumor progression of the residual part, which was managed by fractionated stereotactic radiotherapy or with additional surgery.