Incidence and risk factors associated with reoperation for sellar hematoma following endoscopic transsphenoidal pituitary surgery

OBJECTIVEPostoperative sellar hematoma is an uncommon complication of endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma that often requires emergency surgical evacuation. Sellar hematomas can cause mass effect and compress parasellar structures, leading to clinically significant symptoms such as visual impairment and severe headache. The objective of this study was to determine the incidence and risk factors associated with reoperation for postoperative hematoma after EETS for pituitary adenoma.METHODSThe authors reviewed a prospectively acquired database of EETS for pituitary adenoma over 13 years at Weill Cornell Medicine, NewYork-Presbyterian Hospital and identified cases that required reoperation for confirmed hematoma. They also reviewed clinical and radiographic data of a consecutive series of patients undergoing EETS for pituitary adenoma who did not have postoperative hematoma, which served as the control group. Demographic data and risk factors were compared between the groups using univariate and multivariate analyses via binary logistic regression.RESULTSAmong a cohort of 583 patients undergoing EETS for pituitary adenoma, 9 patients (1.5%) required operation for sellar hematoma evacuation. All 9 patients with reoperation for sellar hematoma presented with worsening in their vision, and severe headache was present in 67%. New postoperative endocrine dysfunction developed in 78%. Clot evacuation improved vision in 88%. The mean time to hematoma evacuation was 4.5 days. The median length of stay for patients with sellar hematoma was 8 days (range 4–210 days) compared with a median length of stay of 3 days (range 1–32 days) for the control patients (p < 0.005). Significant risk factors in univariate analysis were tumor diameter ≥ 30 mm (p < 0.005), suprasellar extension (p < 0.005), tumor volume (p < 0.005), cavernous sinus invasion (p < 0.05), gonadotroph histology (p < 0.05), antiplatelet use (p < 0.05), and elevated BMI (p < 0.05). On multivariate analysis, tumor diameter ≥ 30 mm (OR 4.555, CI 1.30–28.90; p < 0.05) and suprasellar extension (OR 1.048, CI 1.01–1.10; p < 0.05) were found to be the only independent predictors of sellar hematoma. The incidence of hematoma in tumors ≥ 30 mm was 5% (7/139).CONCLUSIONSPostoperative sellar hematoma requiring reoperation is a rare phenomenon after transsphenoidal surgery, often presenting with visual loss and headache. Clot evacuation results in improvement in vision, but long-term endocrinopathy often ensues. Tumor diameter ≥ 30 mm and suprasellar extent are the most reliable risk factors. Close postoperative scrutiny should be given to patients at high risk.

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An unrecognized endocrinology emergency masquerading as a hypertensive emergency: A can’t miss diagnosis

Case Reports in Internal Medicine ◽

10.5430/crim.v4n1p21 ◽

2016 ◽

Vol 4 (1) ◽

pp. 21

Author(s):

Yanerys Agosto Vargas ◽

Sharon Velez Maymi ◽

Paola Mansilla Letelier ◽

Luis Raul Hernandez-Vazquez ◽

Samayra Miranda Rodriguez ◽

...

Keyword(s):

Risk Factors ◽

Pituitary Adenoma ◽

Mortality Rate ◽

Pituitary Gland ◽

Pituitary Apoplexy ◽

Systemic Hypertension ◽

Pituitary Macroadenoma ◽

Rare Entity ◽

Factors Associated ◽

Multiple Risk Factors

Pituitary apoplexy secondary to sellar tumors is a rare entity that carries a high mortality rate. It could be secondary to infarction or hemorrhage of the pituitary gland. The incidence remains unclear, most are reported in men between the ages of 50 to 60. In the majority of times, apoplexy is idiopathic in nature, without a clear discernible cause. However, there are multiple risk factors associated with this entity, such as systemic hypertension, among others. There are few cases of pituitary apoplexy caused by infarction of a pituitary macroadenoma. We present this case of pituitary apoplexy secondary to infarction of a nonfunctional pituitary adenoma in a young woman, with a fortunate resolution.

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Snare technique for the remodeling of the redundant arachnoid pouch to prevent cerebrospinal fluid rhinorrhea and hematoma collection during transsphenoidal surgery for suprasellar-extended pituitary tumors

Journal of Neurosurgery ◽

10.3171/2015.11.jns151328 ◽

2016 ◽

Vol 125 (6) ◽

pp. 1443-1450 ◽

Cited By ~ 2

Author(s):

Ju Hyung Moon ◽

Eui Hyun Kim ◽

Sun Ho Kim

Keyword(s):

Transsphenoidal Surgery ◽

Tumor Resection ◽

Pituitary Tumors ◽

Csf Leak ◽

Arachnoid Membrane ◽

Csf Rhinorrhea ◽

Resection Cavity ◽

Postoperative Hematoma ◽

Csf Leakage ◽

Suprasellar Extension

OBJECTIVE Transsphenoidal surgery (TSS) is considered a most effective treatment for pituitary tumors with huge suprasellar extension. However, the chance of developing CSF leakage is relatively high, because tearing of the arachnoid membrane is common and there could be multiple tear points during the dissection of suprasellar tumors from the overlying arachnoid membrane. If there are multiple leaking points in the arachnoid membrane packing methods such as using fat or multilayered fascia graft may not be sufficient to seal off the leaking points. Moreover, the packing material may not provide sufficient tamponade to stop bleeding, and thus generates postoperative hematoma formation in the tumor resection cavity. To prevent these complications, the authors have developed a new technique for remodeling the redundant arachnoid pouch (the so-called snare technique) to reconstruct the diaphragm, seal off the CSF leak points completely, and reduce the dead space in the tumor resection cavity. METHODS In 9 patients with huge macroadenomas (> 2.5 cm in diameter) with suprasellar extension, the snare technique was used to remodel the arachnoid pouch after tumor removal via standard TSS between July 2009 and August 2014. Complications were investigated, including postoperative CSF rhinorrhea, postoperative hematoma collection, and visual compromise. RESULTS During the resection of the tumor, CSF leakage was encountered in 8 cases, all of which were sealed off using the snare technique. In 1 case without intraoperative CSF leakage, the snare technique was also applied after intentional puncturing of the arachnoid membrane to reduce the volume and tension of the arachnoid pouch. None of the 9 patients experienced postoperative CSF rhinorrhea. Lumbar CSF drainage was not required in any case. Magnetic resonance imaging studies performed 24 hours after surgery revealed a remarkable reduction in the height of the diaphragm in all cases. Visual deficits improved in all patients immediately after surgery. CONCLUSIONS Remodeling of the arachnoid pouch using the snare technique is simple and effective for completely sealing off the CSF leak point and preventing hematoma collection in the tumor resection cavity after TSS for huge pituitary tumors with suprasellar extension.

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Impact of tumor characteristics and pre- and postoperative hormone levels on hormonal remission following endoscopic transsphenoidal surgery in patients with acromegaly

Neurosurgical FOCUS ◽

10.3171/2020.3.focus2080 ◽

2020 ◽

Vol 48 (6) ◽

pp. E10 ◽

Cited By ~ 1

Author(s):

Tyler Cardinal ◽

Martin J. Rutkowski ◽

Alexander Micko ◽

Mark Shiroishi ◽

Chia-Shang Jason Liu ◽

...

Keyword(s):

Pituitary Adenoma ◽

Medical Therapy ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Cranial Nerves ◽

Elevated Serum ◽

Tumor Control ◽

Tumor Diameter ◽

Endoscopic Endonasal ◽

Csf Leakage

OBJECTIVEAcromegaly is a disease of acral enlargement and elevated serum levels of insulin-like growth factor–1 (IGF-1) and growth hormone (GH), usually caused by a pituitary adenoma. A lack of consensus on factors that reliably predict outcomes in acromegalic patients following endoscopic endonasal transsphenoidal surgery (EETS) warrants additional investigation.METHODSThe authors identified 52 patients with acromegaly who underwent an endoscopic endonasal approach (EEA) for resection of a GH-secreting pituitary adenoma. Preoperative and postoperative tumor and endocrinological characteristics such as tumor size, invasiveness, and GH/IGF-1 levels were evaluated as potential indicators of postoperative hormonal remission. Endocrinological remission was defined as postoperative IGF-1 levels at or below the age- and sex-normalized values.RESULTSThe 52 patients had a mean age of 50.7 ± 13.4 years and a mean follow-up duration of 24.4 ± 19.1 months. Ten patients (19%) had microadenomas and 42 (81%) had macroadenomas. Five patients (9.6%) had giant adenomas. Forty-four tumors (85%) had extrasellar extension, with 40 (77%) exhibiting infrasellar invasion, 18 (35%) extending above the sella, and 7 (13%) invading the cavernous sinuses. Thirty-six patients (69%) underwent gross-total resection (GTR; mean maximal tumor diameter 1.47 cm), and 16 (31%) underwent subtotal resection (STR; mean maximal tumor diameter 2.74 cm). Invasive tumors were significantly larger, and Knosp scores were negatively correlated with GTR. Thirty-eight patients (73%) achieved hormonal remission after EEA resection alone, which increased to 87% with adjunctive medical therapy. Ninety percent of patients with microadenomas and 86% of patients with macroadenomas achieved hormonal remission. Preoperative IGF-1 and postoperative day 1 (POD1) GH levels were inversely correlated with hormonal remission. Postoperative CSF leakage occurred in 2 patients (4%), and none experienced vision loss, death, or injury to internal carotid arteries or cranial nerves.CONCLUSIONSEndoscopic transsphenoidal resection of GH-secreting pituitary adenomas is a safe and highly effective treatment for achieving hormonal remission and tumor control in up to 87% of patients with acromegaly when combined with postoperative medical therapy. Patients with lower preoperative IGF-1 and POD1 GH levels, with less invasive pituitary adenomas, and who undergo GTR are more likely to achieve postoperative biochemical remission.

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Risk Factors For Postoperative Cerebrospinal Fluid Leakage After Transsphenoidal Surgery For Pituitary Adenoma: A Meta-Analysis And Systematic Review

10.21203/rs.3.rs-601428/v1 ◽

2021 ◽

Author(s):

Zhihuan Zhou ◽

Feifei Zuo ◽

Xiaoqun Chen ◽

Qinqin Zhao ◽

Mengna Luo ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cerebrospinal Fluid ◽

Pituitary Adenoma ◽

Cohort Studies ◽

Transsphenoidal Surgery ◽

Case Control ◽

Cochrane Library ◽

Cerebrospinal Fluid Leakage ◽

Csf Leakage

Abstract Objective: Postoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA).Methods: PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case–control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors.Results: A total of 34 case–control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18–6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69).Conclusions: This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.

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Risk factors for postoperative intracranial infections in patients with pituitary adenoma after endoscopic endonasal transsphenoidal surgery: pneumocephalus deserves further study

Neurosurgical FOCUS ◽

10.3171/2019.5.focus19269 ◽

2019 ◽

Vol 47 (2) ◽

pp. E5 ◽

Cited By ~ 2

Author(s):

Kang Guo ◽

Lijun Heng ◽

Haihong Zhang ◽

Lei Ma ◽

Hui Zhang ◽

...

Keyword(s):

Risk Factors ◽

Pituitary Adenoma ◽

Pituitary Adenomas ◽

Transsphenoidal Surgery ◽

Bubble Diameter ◽

Csf Leak ◽

Endoscopic Endonasal ◽

Cns Infections ◽

Endoscopic Endonasal Transsphenoidal Surgery ◽

Intracranial Infections

OBJECTIVEThe authors sought to identify the relevance between pneumocephalus and postoperative intracranial infections, as well as bacteriological characteristics and risk factors for intracranial infections, in patients with pituitary adenomas after endoscopic endonasal transsphenoidal surgery.METHODSIn total, data from 251 consecutive patients with pituitary adenomas who underwent pure endoscopic endonasal transsphenoidal surgeries from 2014 to 2018 were reviewed for preoperative comorbidities, intraoperative techniques, and postoperative care.RESULTSThis retrospective study found 18 cases of postoperative pneumocephalus (7.17%), 9 CNS infections (3.59%), and 12 CSF leaks (4.78%). Of the patients with pneumocephalus, 5 (27.8%) had CNS infections. In patients with CNS infections, the culture results were positive in 7 cases and negative in 2 cases. The statistical analysis suggested that pneumocephalus (maximum bubble diameter of ≥ 1 cm), diaphragmatic defects (intraoperative CSF leak, Kelly grade ≥ 1), and a postoperative CSF leak are risk factors for postoperative CNS infections.CONCLUSIONSIn pituitary adenoma patients who underwent pure endoscopic endonasal transsphenoidal surgeries, intraoperative saddle reconstruction has a crucial role for patients with postoperative intracranial infections. Additionally, postoperative pneumocephalus plays an important role in predicting intracranial infections that must not be neglected. Therefore, neurosurgeons should pay close attention to the discovery of postoperative intracranial pneumocephalus because this factor is as important as a postoperative CSF leak. Pneumocephalus (maximum bubble diameter of ≥ 1 cm), diaphragmatic defects (an intraoperative CSF leak, Kelly grade ≥ 1), and a postoperative CSF leak were risk factors predictive of postoperative intracranial infections. In addition, it is essential that operative procedures be carefully performed to avoid diaphragmatic defects, to reduce exposure to the external environment, and to decrease patients’ suffering.

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Risk factors for postoperative cerebrospinal fluid leakage after transsphenoidal surgery for pituitary adenoma: a meta-analysis and systematic review

BMC Neurology ◽

10.1186/s12883-021-02440-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhihuan Zhou ◽

Feifei Zuo ◽

Xiaoqun Chen ◽

Qinqin Zhao ◽

Mengna Luo ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Cerebrospinal Fluid ◽

Pituitary Adenoma ◽

Cohort Studies ◽

Transsphenoidal Surgery ◽

Case Control ◽

Cochrane Library ◽

Cerebrospinal Fluid Leakage ◽

Csf Leakage

Abstract Objective Postoperative cerebrospinal fluid (CSF) leakage represents a challenge even for experienced pituitary surgeons. We aimed to quantitatively synthesize data from studies regarding the risk factors for postoperative CSF leakage after transsphenoidal surgery (TSS) for pituitary adenoma (PA). Methods PubMed, Web of Science, The Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Wanfang database, and VIP database were searched for case–control and cohort studies, focusing on the risk factors associated with postoperative CSF leakage after TSS for PA. Pooled odds ratios (ORs) and 95% confidence intervals were calculated to determine the risk factors. Results A total of 34 case–control and cohort studies involving a total of 9,144 patients with PA were included in this systematic review. The overall rate of postoperative CSF leakage after TSS for PA was 5.6%. Tumor size, adenoma consistency, revision surgery, and intraoperative CSF leakage were independent risk factors for postoperative CSF leakage (ORs, 3.18–6.33). By contrast, the endoscopic approach showed a slight protective benefit compared with the microscopic approach in TSS (OR, 0.69). Conclusions This review provides a comprehensive overview of the quality of the evidence base, informing clinical staff of the importance of screening risk factors for postoperative CSF leakage after TSS for PA. More attention should be paid to PA patients at high risk for CSF leakage after TSS to reduce complications and improve prognosis.

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Evaluation of Pure Endoscopic Endonasal Approach in Management of Giant Pituitary Adenoma

QJM ◽

10.1093/qjmed/hcab108.008 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Mina M Gerges ◽

Hatem Sabry ◽

Hasan Jalalod din ◽

Mohamed Ashraf Ghobashy ◽

Theodore H Schwartz

Keyword(s):

Radiation Therapy ◽

Pituitary Adenoma ◽

Cavernous Sinus ◽

Transsphenoidal Approach ◽

Csf Leak ◽

Tumor Diameter ◽

Giant Pituitary Adenoma ◽

Postoperative Hematoma ◽

Extended Transsphenoidal Approach

Abstract Background Giant pituitary adenoma represents one of the challenging tumor for neurosurgeons. Many microsurgical approaches in the past were used for its management. Recently and with evolution of the endoscopic equipment and instruments, extended endoscopic transsphenoidal approach become one of the preferable approaches for its surgical excision. Methods We prospectively document the clinical , surgical and follow up data for all patients presented with giant pituitary adenoma to Ain-Shams university hospital and Weill Cornell Medical College, Presbyterian hospital and were surgically treated with extended transsphenoidal approach from 2015 till 2019. Results Our group study formed of 44 patients with mean age 53.03 (range 14.7-82.4) and a male predominance (59%). The main presentation was visual problems in 75% followed by partial hypopituitarism in 31.81% while headache was in 13.64%. Only 4 patients had functioning adenoma (3 prolactinoma and 1 acromegaly). Average tumor volume was 26.95 ± 17.25 cm3, while the mean maximum tumor diameter was 4.73 cm (range 4.0-8.0 cm). Radiographic invasion was found in 97.73% to suprasellar cistern, 61.36% to the cavernous sinus and in 34% to the sphenoid sinus. GTR was achieved in 45.45% with Knosp score is the only significant predictor factor for resection rate (p = 0.04). Visual improvement achieved in 75.76%. 50% (2 patient) of the patients with functioning adenoma were cured. Complications included CSF leak in 3 patients, permanent DI in 4 patients and postoperative hematoma in 2 patients. Recurrence and progression rates without upfront radiation therapy were 5.00 % and 31.81% respectively after mean follow up period 57.90 months. Conclusions Extended endoscopic approaches for achieving maximum resection with minimal morbidity for giant pituitary adenoma are very effective. Lateral tumor extension with cavernous sinus invasion represents the limiting point in achieving gross total resection. Upfront radiation therapy for patients with residual adenoma can be avoided but regular follow up should be warranted.

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152 Complications Associated with Transsphenoidal Pituitary Surgery: Experience of 1171 Consecutive Cases Treated at a Single Tertiary Care Pituitary Center

Neurosurgery ◽

10.1093/neuros/nyx417.152 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 237-237 ◽

Cited By ~ 3

Author(s):

Matthew Agam ◽

Michelle Ariana Wedemeyer ◽

John D Carmichael ◽

Martin H Weiss ◽

Gabriel Zada

Keyword(s):

Risk Factors ◽

Diabetes Insipidus ◽

Transsphenoidal Surgery ◽

Vision Loss ◽

Perioperative Complications ◽

Vegetative State ◽

Tertiary Care ◽

Complication Rates ◽

Major Complications ◽

Postoperative Hematoma

Abstract INTRODUCTION Pituitary adenomas (PAs) are benign neoplasms frequently encountered during workup for endocrinopathy, headache, or visual loss. Transsphenoidal surgery remains the mainstay approach for PA resection. We retrospectively assessed safety and complication rates associated with transsphenoidal PA resection. METHODS The USC Pituitary Center REDCap electronic database was used to identify 1171 consecutive patients who underwent microscopic (85%) or endoscopic (15%) transsphenoidal PA resection at Keck Hospital of USC between November 1992 - March 2017. A retrospective analysis of perioperative complications and patient/tumor risk factors was conducted. RESULTS >There were 2 perioperative mortalities (0.2%) in this series. Additional surgical complications included cerebrospinal fluid leak (2.6%), new neurological deficit (1.3%), meningitis (1.0%), postoperative hematoma (1%), cranial nerve paresis (0.9%), hydrocephalus (0.7%), vision loss (0.6%), stroke (0.4%), vegetative state (0.1%) and carotid artery injury (0.1%). Perioperative medical complications included bacteremia/sepsis (0.5%), pneumonia (0.4%), myocardial infarction (0.3%), and DVT/PE (0.2%). Endocrine complications were the most frequent, including transient diabetes insipidus (4.5%), symptomatic hyponatremia (4.3%), permanent diabetes insipidus (0.3%), and new hypopituitarism (3.8%). There were no significant differences between microscopic versus endoscopic approaches with regard to overall complications (16.9% vs. 19.1%; P = 0.513) or major complications (5% vs. 4%; P = 0.601). Risk factors for major complications included: prior transsphenoidal surgery (8.5% versus 4.5%; P = 0.043), prior craniotomy (23.5% versus 4.5%; P = 0.001), prior radiosurgery (33.3% versus 4.5%, P = 0.007), presence of PA invasion on MRI (7.0% versus 2.4%; P = 0.001), and preoperative vision loss (8.8% versus 5.0%; P < 0.001). CONCLUSION In one of the largest studies assessing complications associated with transsphenoidal PA resection, the rate of death or major disability was 0.26%. Risk factors for complications included prior surgical/radiosurgical treatment and PA invasion. No differences in complication rates between endoscopic and microscopic surgery were observed. When performed at experienced pituitary centers, safety rates for patients undergoing transsphenoidal PA resection are extremely high.

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Preoperative and Postoperative Nomograms in Predicting Early Recurrence of Hepatocellular Carcinoma Without Macrovascular Invasion After Curative Resection

10.21203/rs.3.rs-891054/v1 ◽

2021 ◽

Author(s):

Yanfang Zhang ◽

Liangliang Xu ◽

Mingqing Xu ◽

Hong Tang

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Validation Cohort ◽

Predictive Performance ◽

Early Recurrence ◽

Tumor Diameter ◽

Training Cohort ◽

Factors Associated ◽

Tumor Number ◽

Before And After

Abstract This study aimed to establish pre- and postoperative nomograms in predicting postoperative early recurrence (ER) for hepatocellular carcinoma (HCC) without macrovascular invasion. The patients who underwent curative LR for HCC from January 2012 to December 2016 in our center were divided into training and internal prospective validation cohorts. Nomograms were constructed based on the independent risk factors derived from multivariate logistic regression analyses in training cohort. The predictive performance of nomograms was validated by internal prospective validation cohort. A total of 698 patients fulfilled with eligible criteria. Among them, 265 out of 482 patients (55.0%) in training cohort and 120 out 216 (55.6%) patients in validation cohort developed ER. The preoperative risk factors associated with ER were age, alpha fetoprotein (AFP), tumor diameter, tumor number; the postoperative risk factors associated with ER were age, tumor diameter, tumor number, microvasular invasion (MVI) and differentiation. The pre- and postoperative nomograms based on these factors showed good accuracy with C-indices of 0.712 and 0.850 in training cohort, and 0.754 and 0.857 in validation cohort, respectively. The calibration curves showed optimal agreement between the prediction by the nomograms and actual observation. The area under the receiver operating characteristic curves of pre- and postoperative nomograms were 0.721 and 0.848 in training cohort, and 0.754 and 0.844 in validation cohort, respectively. Present nomograms showed good performance in predicting ER for HCC without macrovascular invasion before and after surgery, which were helpful for doctors in designation of treatments and selection of patients for regularly surveillance or administration of neoadjuvant therapies.

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Preoperative Surgical Risk Assessment by Evaluation of Tumor Blood Flow Using Perfusion Imaging by Computed Tomography in Transsphenoidal Surgery for Pituitary Adenoma

10.21203/rs.3.rs-39578/v1 ◽

2020 ◽

Author(s):

Nakamasa Hayashi ◽

Koichi Mitsuya ◽

Shoichi Deguchi ◽

Atsushi Urikura ◽

Masahiro Endo

Keyword(s):

Computed Tomography ◽

Blood Flow ◽

Transsphenoidal Surgery ◽

Mean Value ◽

Tumor Diameter ◽

Preoperative Prediction ◽

Perfusion Studies ◽

Incomplete Removal ◽

Significant Difference ◽

Suprasellar Extension

Abstract Background: Complete removal of large and giant pituitary adenomas (PAs) with suprasellar extension by transsphenoidal surgery (TSS) is sometimes difficult. Swelling and bleeding of a residual suprasellar tumor after incomplete removal via TSS can compress the surrounding neurovascular structures, resulting in postoperative complications. We measured PA blood flow by perfusion computed tomography (PCT) and assessed its usefulness in the preoperative prediction of postoperative hemorrhagic complications after TSS.Method: We performed PCT in 28 patients with PAs with suprasellar extension before TSS. Perfusion studies were performed with a 320-row multidetector computed tomography system. We measured cerebral blood volume (CBV) and cerebral blood flow (CBF) of the tumor (CBVt and CBFt) and normal-appearing white matter (CBVw and CBFw).Results: In all patients, CBVt was greater than CBVw. There was a statistically significant difference between CBFt and CBFw (p < 0.0001). The patients were divided into 2 groups according to CBFt: high CBF (CBFt> mean value) and low CBF (CBFt< mean value). There were no statistically significant differences between the 2 groups in terms of gender, age, maximum tumor diameter, suprasellar extension grade, and extent of resection. Two of the 7 patients in the high CBF group suffered from visual acuity deterioration and visual field stenosis due to postoperative hemorrhage, while no patients in the low CBF group did (p = 0.014).Conclusions: PCT may be useful in the preoperative prediction of postoperative residual tumor hemorrhage, which can be a hazardous postoperative complication after TSS for large and giant PAs.

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