Introduction: Pituitary Macroadenomas are a common type of pituitary tumors. A small subset of these are Giant Adenomas. There is no scoring system that extensively takes into account all the dimensions of adenoma invasion together. We developed a new Giant Pituitary adenoma score and report our surgical experience& evaluate outcomes after resection of these tumors in accordance with the preoperative score.
Methods: A retrospective study conducted at Section of Neurosurgery,Aga Khan University, Karachi, Pakistan. AKUH GPA score was developed. Bilateral Paraclival extension(1+1), complete ICA encasement(1+1), supra sellar extension 2cm above trans-carotid line(1), retro-clival extension 2 cm posterior to clival line (1), intraventricular extension(1), extension into different cranial fossa(1+1). Maximum score was 9. A retrospective analysis of 52 patients of Giant Pituitary Adenoma, maximum diameter=4cm, underwent surgical resection, between January 1,2006, and December, 2017 were included. AKUH GPA Score was applied. Outcomes were evaluated using linear regression.
Results: The median score was 5 (range 2 to 7). The median age was 42, most common symptom visual deterioration in 91% of cases. Mean preoperative tumor diameter was 5 cm and mean volume was 35ml. Most cases with AKUH GPA scores 2 - 6 were operated with trans-sphenoidal microscopic approach in 27, endoscopic endonasal approach in 5, endoscope assisted microscopic approach in 12 cases. Trans-cranial resection was done in 8 cases, 4 cases had a score of 6 & 4 cases had a score of 7. All score 7 and 2 score 6 cases had staged Trans-cranial and trans-sphenoidal approach. The mean resection rate was 76%. AKUH GPA score was correlated with the percent residual tumor using linear regression that was statistically significant P= 0.017.
Conclusions: AKUH Giant Pituitary Adenoma score is a reliable method to predict the extent and subsequent difficulty in tumor resection in Giant Pituitary Adenomas. Score = 6 may require trans-cranial resection
Patient Care: AKUH Giant Pituitary Adenoma Score is a simple score and can be used to predict the difficulty in tumor resection using trans-sphenoidal approach, pre-operative planning by surgeons along with patient counselling can be done. Alternate approaches can be planned for favourable outcomes.
Learning Objectives: Outcomes of Giant Pituitary Adenomas in relation to the novel AKUH Giant Pituitary Adenoma Score.