Two-stage surgical treatment of giant pituitary adenomas


  • Oleksandr Voznyak Center of Neurosurgery, Feofaniya Сlinical Hospital, Kiev, Ukraine
  • Oleg Maydannyk Center of Neurosurgery, Feofaniya Сlinical Hospital, Kiev, Ukraine



giant pituitary adenoma, two-stage surgery, endonasal (transsphenoidal) approach, transcranial intervention


Introduction. Surgical treatment of invasive giant pituitary adenomas (GPA) with sub- and intracranial growth is a complex problem due to a high risk of their one-stage removing. Own experience of two-stage surgical treatment of patients with GPA, needed combined surgical approaches was generalized.

Materials and methods. 9 cases of two-stage surgical treatment of patients with GPA are given. Patients’ average age was 41.3 years, there were 5 women and 4 men. 18 operations with surgical approaches combination were performed: 10 — using transsphenoidal, and 8 — transcranial approach.

Results. None of the tumor was removed radically, subtotal resection (70–90% of the tumor) was performed in 5 cases; almost full resection (more than 90%) — in 4, all patients were alive. Complications and their course in early postoperative period were described.

Conclusions. Two-stage surgical treatment of patients with GPA is effective and provides long-term clinical results. Combination of transcranial and transsphenoidal approaches for GPA removing permits to use advantages of both.


1. Patsko YaV. Adenomy gipofiza s obshirnym ekstrasellyarnym raspostraneniyem [Pituitary adenomas with extensive proliferation ekstrasellyarnym] [dissertation]. Kiev (Ukraine): Ukrainian Research Institute of Neurosurgery; 1987. Russian.

2. Symon L, Jakubowski J, Kendall B. Surgical treatment of giant pituitary adenomas. J Neurol Neurosurg Psychiatry. 1979 Nov;42(11):973-82. [PubMed] [CrossRef]

3. Mortini P, Barzaghi R, Losa M, Boari N, Giovanelli M. Surgical treatment of giant pituitary adenomas: strategies and results in a series of 95 consecutive patients. Neurosurgery. 2007 Jun;60(6):993-1002; discussion 1003-4. [PubMed] [CrossRef]

4. Wilson CB. A decade of pituitary microsurgery. The Herbert Olivecrona lecture. J Neurosurg. 1984 Nov;61(5):814-33. [PubMed] [CrossRef]

5. D'Ambrosio AL, Syed ON, Grobelny BT, Freda PU, Wardlaw S, Bruce JN. Simultaneous above and below approach to giant pituitary adenomas: surgical strategies and long-term follow-up. Pituitary. 2009;12(3):217-25. [PubMed] [CrossRef]

6. Patsko IaV. [Surgical tactics in recurring pituitary adenomas]. Klin Khir. 1981 Dec;(12):22-6. Russian. [PubMed]

7. Kadashev BA, Trunin IuK, Kornienko VN, Kalinin PL. [The staged use of transcranial and transphenoidal surgical approaches in treating hypophyseal adenomas]. Zh Vopr Neirokhir Im N N Burdenko. 1996 Oct-Dec;(4):6-10. Russian. [PubMed]

8. Barrow DL, Tindall GT. Combined simultaneous transsphenoidal transcranial operative approach to selected sellar tumors. Perspect Neurol Surg. 1992;(3):49.

9. Alleyne CH Jr, Barrow DL, Oyesiku NM. Combined transsphenoidal and pterional craniotomy approach to giant pituitary tumors. Surg Neurol. 2002 Jun;57(6):380-90; discussion 390. [PubMed] [CrossRef]



How to Cite

Voznyak, O., & Maydannyk, O. (2013). Two-stage surgical treatment of giant pituitary adenomas. Ukrainian Neurosurgical Journal, (2), 39–44.



Original articles