Abstract

Abstract

Objectives: evaluate late outcomes after transsphenoidal endoscopic resection and post stereotactic gamma knife radiosurgery on pituitary macroadenomas in terms of clinical features and radiological response.

Methods: This study was conducted at Ghazi Al-Hariri hospital for surgical specialties and Saad Al-Witry neuroscience teaching hospital in the period extended from January 2020 to January 2023. The study included a total number of 113 cases.



Results: Total tumour volume reduction to a normal gland size was achieved in 42 cases out of the total patient number (37%) (All of which were of the transsphenoidal group), small tumour residual was found in 37 cases (33%) (11 patients in the transsphenoidal group, 26 patients in the gamma knife group), large tumour residual was found in 34 cases (30%) (4 patients in the transsphenoidal group, 30 patients in the gamma knife group).



Conclusions: Transsphenoidal resection is ideal for young fit patients with large tumours manifesting with visual compromise, non-response to medical therapy or as an emergency intra-tumoural haemorrhage (apoplexy).

Stereotactic radiosurgery, on the other hand, is best suitable for residual or recurrent disease or in patients in whom surgery is deemed extremely hazardous such as elderly patients or patients with medical comorbidities.



Key word

Pituitary adenoma, prolactinoma, transsphenoidal resection, gamma knife radiosurgery.