Cerebral infarction as unexpected severe postoperative complication in giant pituitary neuroendocrine tumors

Surgical treatment of giant pituitary neuroendocrine tumors (PitNETs) is considered challenging due to the high rates of postoperative complications. Understanding of the postoperative complications of giant PitNETs is important both to improve treatment outcomes and to make the proper preoperative informed consent for the patient. Institutional clinical data of 100 consecutive PitNETs patients who underwent surgical treatment between January 2015 and December 2024 were retrospectively reviewed. Cases of giant PitNETs were identified and compared with cases of non-giant PitNETs. This study included 19 giant PitNETs patients and found no significant differences in age, sex, operation time, or recurrence rate between the two groups. The median postoperative hospital stay was significantly longer in patients with giant PitNETs (15.0 vs. 12.0 days, p = 0.01). The incidence of postoperative cerebral infarction was significantly higher in patients with giant PitNETs (4 vs. 0 cases, p < 0.01). Four patients developed postoperative cerebral infarction caused by intraoperative perforator injury in one case and mechanical compression of the cerebral artery by hemorrhage within the residual tumor in three cases. There were no significant differences in the incidence of cerebrospinal fluid leakage, hypopituitarism, diabetes insipidus, or visual field deterioration. Giant PitNETs carry the risk of postoperative cerebral infarction. These findings suggest that maximal safe tumor removal may reduce the risk of postoperative cerebral infarction in giant PitNETs by reducing the residual tumor hemorrhage. Before surgery for giant PitNETs, surgeons must fully inform patients about the risk of postoperative cerebral infarction.