A Giant Pituitary Adenoma: Surgical Excision via a Staged Endoscopic and Open Approach

The operative management of giant pituitary adenomas represents a significant challenge for neurosurgeons. This challenge is amplified by the degree of local tumour infiltration into adjacent structures such as the cavernous sinus. The degree of parasellar tumour extension can be classified according to the Knosp grading system’ while suprasellar extension is qualified in accordance with the Modified Hardys classification system. We report a 59 year male with a Knosp grade 4, Hardys C giant pituitary adenoma in which two-stage near total surgical resection via an expanded endoscopic transphenoidal approach and subsequent bifrontal craniotomy was achieved. Typically, resection rates of less than 50% have been reported following surgery on giant pituitary adenomas. Traditionally multi-modal treatment strategies with adjuvant stereotactic radiotherapy or radio surgery, has been the gold standard in the management of these locally aggressive tumours. This case serves to illustrate that even in the presence of significant suprasellar and parasellar extension, radical resection of giant pituitary adenomas can be achieved.