Routine MRI Assessment Immediately Following Transsphenoidal Resection of Nonfunctional Pituitary Macroadenomas Does Not Alter the Course of Clinical Management

Abstract BACKGROUND: Delayed ischemic events due to vasospasm are a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). Severe vasospasm in other neurosurgical settings is not as well recognized. Delay in diagnosis and treatment of vasospasm in such settings may be associated with significant neurological morbidity. OBJECTIVE: To present three cases of symptomatic delayed cerebral vasospasm after transsphenoidal resection of pituitary macroadenomas. METHODS: Transsphenoidal resection in all cases was complicated by peritumoral hemorrhage with extension into the subarachnoid space. Two of the 3 patients required re-operation to evacuate the hematoma in the tumor bed because of progressive worsening neurological deficits. RESULTS: All 3 patients developed vasospasm of the intracranial vessels, starting as early as postoperative day 5 and appearing as late as postoperative day 10. Comparisons to the non-vascular pre-operative magnetic resonance imaging studies confirmed the “de-novo” nature of the vasospasm based on the caliber of the flow voids. CONCLUSION: Transsphenoidal surgery complicated by peritumoral hemorrhage is associated with a significant risk of neurological morbidity because of delayed cerebral vasospasm. Early recognition and management according to guidelines used for postaneurysmal SAH may help to improve outcomes in these patients.

Download Full-text

Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas.

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jcem.79.2.8045946 ◽

1994 ◽

Vol 79 (2) ◽

pp. 348-354 ◽

Cited By ~ 4

Author(s):

B M Arafah ◽

S H Kailani ◽

K E Nekl ◽

R S Gold ◽

W R Selman

Keyword(s):

Pituitary Function ◽

Immediate Recovery ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

Download Full-text

Early versus late Gamma Knife radiosurgery following transsphenoidal resection for nonfunctioning pituitary macroadenomas: a matched cohort study

Journal of Neurosurgery ◽

10.3171/2015.5.jns15581 ◽

2016 ◽

Vol 125 (1) ◽

pp. 202-212 ◽

Cited By ~ 13

Author(s):

I. Jonathan Pomeraniec ◽

Robert F. Dallapiazza ◽

Zhiyuan Xu ◽

John A. Jane ◽

Jason P. Sheehan

Keyword(s):

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Expectant Management ◽

Pituitary Insufficiency ◽

Increased Risk ◽

Late Treatment ◽

Early Cohort ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

OBJECT Gamma Knife radiosurgery (GKRS) is frequently employed to treat residual or recurrent nonfunctioning pituitary macroadenomas. There is no consensus as to whether GKRS should be used early after surgery or if radiosurgery should be withheld until there is evidence of radiographic progression of tumor. METHODS This is a retrospective review of patients with nonfunctioning pituitary macroadenomas who underwent transsphenoidal surgery followed by GKRS between 1996 and 2013 at the University of Virginia Health System. Patients were stratified based on the interval between resection and radiosurgery. Operative results and imaging and clinical outcomes were compared across groups following early (≤ 6 months) or late (> 6 months) radiosurgery. RESULTS Sixty-four patients met the study criteria and were grouped based on early (n = 32) or late (n = 32) GKRS following transsphenoidal resection. There was a greater risk of tumor progression after GKRS in the late radiosurgical group (p = 0.027) over a median radiographic follow-up period of 68.5 months. Furthermore, there was a significantly higher occurrence of post-GKRS endocrinopathy in the late radiosurgical cohort (p = 0.041). Seventeen percent of patients without endocrinopathy in the early cohort developed new endocrinopathies during the follow-up period versus 64% in the late cohort (p = 0.036). This difference was primarily due to a significantly higher rate of tumor growth during the observation period of the late treatment cohort (p = 0.014). Of these patients with completely new endocrinopathies, radiation-associated pituitary insufficiency developed in 1 of 2 patients in the early group and in 3 of 7 (42.9%) patients in the late group. CONCLUSIONS Early treatment with GKRS appears to decrease the rate of radiographic and symptomatic progression of subtotally resected nonfunctioning pituitary macroadenomas compared with late GKRS treatment after a period of expectant management. Delaying radiosurgery may place the patient at increased risk for adenoma progression and endocrinopathy.

Download Full-text

Residual anterior pituitary function following transsphenoidal resection of pituitary macroadenomas

Journal of Neurosurgery ◽

10.3171/jns.1984.61.3.0577 ◽

1984 ◽

Vol 61 (3) ◽

pp. 577-580 ◽

Cited By ~ 51

Author(s):

Alfred T. Nelson ◽

H. St. George Tucker ◽

Donald P. Becker

Keyword(s):

Anterior Pituitary ◽

Transsphenoidal Surgery ◽

Normal Function ◽

Pituitary Function ◽

Acceptable Risk ◽

Content Type ◽

Anterior Pituitary Function ◽

Improved Function ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

✓ A series of 84 patients with pituitary adenomas greater than 1 cm in diameter is presented. Full preoperative and postoperative endocrine evaluations were carried out, and the effects of transsphenoidal surgery on remaining anterior pituitary function were analyzed. Of the patients who had normal anterior pituitary function before surgery, 78% retained normal function after surgery. Thirty-three percent of those patients with pituitary deficits who did not have panhypopituitarism before surgery had improved function after surgery; 33% had worsened function after surgery. None of the patients with panhypopituitarism before surgery regained function after surgery. Transsphenoidal surgery carries an acceptable risk for sacrificing anterior pituitary function, but the risk is greater in patients with larger tumors and preoperatively compromised pituitary function.

Download Full-text

Diaphragma Sellae: A Surgical Reference for Transsphenoidal Resection of Pituitary Macroadenomas

World Neurosurgery ◽

10.1016/j.wneu.2010.08.002 ◽

2011 ◽

Vol 75 (2) ◽

pp. 286-293 ◽

Cited By ~ 6

Author(s):

Gerardo Guinto Balanzar ◽

Miguel Abdo ◽

Moises Mercado ◽

Patricia Guinto ◽

Elisa Nishimura ◽

...

Keyword(s):

Diaphragma Sellae ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

Download Full-text

Magnetic resonance imaging characteristics of residual pituitary tissues following transsphenoidal resection of pituitary macroadenomas

Neurology India ◽

10.4103/0028-3886.325377 ◽

2021 ◽

Vol 69 (4) ◽

pp. 867

Author(s):

Shousen Wang ◽

Deyong Xiao ◽

Kunzhe Lin ◽

Lin Zhao ◽

Liangfeng Wei

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Imaging Characteristics ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

Download Full-text

Tumor to Cerebellar Peduncle T2-Weighted Imaging Intensity Ratio Fails to Predict Pituitary Adenoma Consistency

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1668516 ◽

2018 ◽

Vol 80 (03) ◽

pp. 252-257 ◽

Cited By ~ 1

Author(s):

Panagiotis Mastorakos ◽

Gautam U. Mehta ◽

Ajay Chatrath ◽

Shayan Moosa ◽

Maria-Beatriz Lopes ◽

...

Keyword(s):

Intensity Ratio ◽

Preoperative Planning ◽

Radiographic Finding ◽

Resonance Imaging ◽

The Mean ◽

Cerebellar Peduncle ◽

Tumor Consistency ◽

Growth Hormone Secreting Adenomas ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

Object The consistency of pituitary macroadenomas affects the complexity of surgical resection. On T2-weighted (T2W) imaging, the intensity ratio of the tumor to the cerebellar peduncle (tumor to cerebellar peduncle T2-weighted imaging intensity [TCTI] ratio) correlates with meningioma consistency. We aimed to determine the correlation of this radiographic finding with pituitary macroadenoma consistency and to determine whether it can be used for preoperative planning. Methods We performed a retrospective evaluation of 196 patients with macroadenomas who underwent endoscopic transsphenoidal resection from January 2012 to June 2017. Macroadenoma consistency was determined by one senior neurosurgeon at the time of surgery. Axial and coronal T2W magnetic resonance imaging images were evaluated retrospectively, and adenoma size, Knosp grade, suprasellar extension and TCTI were calculated. Results The mean TCTI ratio was 1.70 (95% confidence interval [CI]: 1.65–1.75). Intraoperatively, 140 (71.4%) adenomas were classified as soft and 48 (24.5%) as fibrous. Gross total resection was achieved in 66.7% of fibrous adenomas and in 86.4% of soft adenomas (p = 0.007). The mean ratio was 1.68 (95% CI: 1.62–1.74) for soft tumors and 1.76 (95%CI: 1.67–1.84) for fibrous tumors. There was no difference in the mean TCTI ratio between groups. Lactotroph and somatotroph adenomas had a lower mean TCTI ratio compared with other functioning and nonfunctioning adenomas with a mean TCTI of 1.52 compared with 1.77. Conclusions In this retrospective cohort study, we found that the TCTI ratio does not correlate with tumor consistency. We also noted that the TCTI ratio is increased in prolactin and growth hormone-secreting adenomas.

Download Full-text