Abstract
PURPOSE: Combined surgical strategy with both trans-cranial surgery and trans-sphenoid surgery is necessary for selected giant pituitary adenoma with both intra-cranial and intra-sphenoidal invasion. Cases of staged surgery were reviewed retrospectively to deeply investigate this treatment strategy. METHODS: Adult cases received staged surgery were reviewed. Data regarding clinical presentation, laboratory tests, image examination, surgery details, and outcome were analyzed. The size and invasion was evaluated by pre-op MR and intra-op observation. Diagnosis was confirmed by histology examination. Literatures were reviewed. RESULTS: 8 NFPAs were included. 4 received trans-cranial resection first while the other 4 received trans-sphenoidal resection first. Time interval between two operations was 1–2 months. After the first surgery, the rate of visual defects and of pituitary hypofunction improvement were higher in trans-cranial first group. 1 apoplexy and 1 CSF rhinorrhea were observed in trans-sphenoidal first group. After the second surgery, the extend of resection and the rate of complete visual symptoms improvement were higher in trans-cranial first group. All pituitary hypofunction resolved completely in long-term follow-up. 11 literatures were reviewed. CONCLUSIONS: An appropriate surgical strategy is essential for selective pituitary adenoma requiring combined resection. For staged surgery cases, taking trans-cranial approach for first stage with trans-sphenoidal subsequently, comparing to the inverse resection order, would offer higher extent of resection with less recurrence, earlier and better symptom improvement, and less post-op complications after first stage. Further investigation is necessary.