• Salvatore Chibbaro, Francesco Signorelli, Davide Milani, Helene Cebula, Antonino Scibilia, Maria Teresa Bozzi, Raffaella Messina, Ismail Zaed, Julien Todeschi, Irene Ollivier, Charles Henry Mallereau, Guillaume Dannhoff, Antonio Romano, Francesco Cammarota, Franco Servadei, Raoul Pop, Seyyid Baloglu, Giovanni Battista Lasio, Florina Luca, Bernard Goichot, Francois Proust, and Mario Ganau.
• Neurosurgery Unit, Hautepierre Regional Hospital, Strasbourg University, 67200 Strasbourg, France.
• Cancers (Basel). 2021 Jul 18; 13 (14).

PurposeTo evaluate factors influencing clinical and radiological outcome of extended endoscopic endonasal transtuberculum/transplanum approach (EEA-TTP) for giant pituitary adenomas (GPAs).MethodsWe recruited prospectively all consecutive GPAs patients undergoing EEA-TTP between 2015 and 2019 in 5 neurosurgical centers. Preoperative clinical and radiologic features, visual and hormonal outcomes, extent of resection (EoR), complications and recurrence rates were recorded and analyzed.ResultsOf 1169 patients treated for pituitary adenoma, 96 (8.2%) had GPAs. Seventy-eight (81.2%) patients had visual impairment, 12 (12.5%) had headaches, 3 (3.1%) had drowsiness due to hydrocephalus, and 53 (55.2%) had anterior pituitary insufficiency. EoR was gross or near-total in 46 (47.9%) and subtotal in 50 (52.1%) patients. Incomplete resection was associated with lateral suprasellar, intraventricular and/or cavernous sinus extension and with firm/fibrous consistence. At the last follow-up, all but one patient (77, 98.7%) with visual deficits improved. Headache improved in 8 (88.9%) and anterior pituitary function recovered in 27 (50.9%) patients. Recurrence rate was 16.7%, with 32 months mean recurrence-free survival.ConclusionsEEA-TTP is a valid option for GPAs and seems to provide better outcomes, lower rate of complications and higher EoR compared to one- or multi-stage microscopic, non-extended endoscopic transsphenoidal, and transcranial resections.

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