Three hundred and thirty six cases of pituitary adenomas were operated by the transpenoidal route in the last 10 years by a single surgeon. Majority of these were giant non functioning adenomas. Prolactinomas were excluded unless a part of dual adenoma.
In nearly 80% of tumours, total or near total removal was achieved. Long term outcome with follow up of more than 5 years revealed recurrence requiring resurgery in only 4 out of 102 patients. Endocrine recovery was seen in many with permanent added hormonal deficit in around 5% of cases. Added visual deficit was seen in 1 patient.
Mortality was 14 patients and the avoidable reasons will be discussed.The advantages and disadvantages of an aggressive approach in a developing country were the cost of hormonal supplementation is prohibitive will be highlighted.