Predicting resection success in giant pituitary adenomas: morphologic determinants and a preoperative multivariate model

We retrospectively analyzed 60 consecutive patients with giant pituitary adenomas who underwent endoscopic transsphenoidal surgery (ETSS) at a tertiary pituitary center between 2015 and 2023. Clinical, radiological, hormonal, and surgical variables were collected from medical records. Tumor volume, cranial extension pattern, Hardy and Knosp classifications, and multilobulated morphology were evaluated using preoperative MRI. Surgical outcomes, complications, and postoperative endocrine and visual results were recorded. Predictors of resection extent were assessed using multivariate logistic regression, and a preoperative prediction model was developed and evaluated with ROC analysis.