Current concepts and controversies in the management of non-functioning giant pituitary macroadenomas

Despite their histologically benign nature, giant and ‘invasive’ pituitary tumors are one of the most complex neurosurgical challenges. In the present article, we discuss the current approaches to the management of giant pituitary tumors. Giant non-functioning pituitary tumors are usually confined inferiorly by the sellar dura, superiorly by the elevated diaphragma sellae, and laterally by an intact medial wall of the cavernous sinus. If the anatomical extensions of the tumor are understood and a radical tumor resection is achieved, the visual and long-term outcome can be extremely rewarding. The goals of surgery are to make a pathologic diagnosis and since the majority of these tumors are endocrinologically silent, the second goal should be to decompress the neural tissue. With the increasing experience and better understanding of anatomy of these tumors, trans-sphenoidal approaches have now replaced craniotomy for the excision of these tumors.