Endoscopic Endonasal Approach to Giant Pituitary Adenomas in Low-Income Country: Single Surgeon’s Experience from Azerbaijan

Background: Giant pituitary adenomas represent a surgical challenge. Lack of certain equipments, such as navigation system, intraoperative MRI, and others, makes the challenge more difficult to achieve.

Methods: We retrospectively reviewed medical records of 235 patients and identified 32 (22 males, 10 females) with giant pituitary adenoma who underwent an endoscopic endonasal approach from 2014 to 2019 years. The follow-up period ranged from 7 to 64 months (mean: 36).

Results: A transsphenoidal approach was used in the treatment of 32 patients. Mean age of patients was 45 years old. Nonfunctioning tumors were present in 18 (56.25%); among functioning adenomas, 6 patients (18.75%) had GH-secreting tumors and 8 (25%) had prolactinomas. Cavernous sinus invasion has seen in 12 (37.5%) and sphenoid sinus invasion in 7 (22%). Tumor extension to the third ventricle was 5 (16%) and tumor filled third ventricle totally. Tumor extension to the anterior fossa was 4 (12.5%) and to the posterior fossa it was 2 (6.25%). Eighteen tumors (56.25%) demonstrated round shape, 5 (16%) were dumbbell shape, and 9 (28%) were multilobulated.

Gross total and near-total resection was achieved in 28 (87.5%); partial resection was achieved in 4 patients (12.5%). Intraoperative ICA bleeding happened in three (9%) patients, two cases were controlled and carried on and surgical mortality was 3%.

Postoperative improvement in visual acuity was achieved in 23 (72%). Transient diabetes insipidus following surgery occurred in 9 (28%). A total of eight patients (25%) underwent adjuvant medical and/or radiotherapy. CSF leak occurred in four patients managed by lumbar drain (12.5%).

Conclusion: Endoscopic endonasal transsphenoidal surgery is an effective treatment method for patients with giant pituitary adenomas, which results in high rates of resection and improvement in visual function. It is not associated with high rates of major complications and is safe when performed by experienced surgeons.