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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Quantitative volumetric analysis post transsphenoidal pituitary adenoma surgery
Alireza Mansouri1, Sean Symons, Michael Schwartz
1Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
Summary
Immediate postoperative CT scans overestimate residual pituitary adenoma size compared to delayed MRI. Delayed MRI provides a more accurate assessment of tumor reduction and surgical success.
Area of Science:
- Neurosurgery
- Radiology
- Endocrinology
Background:
- Transsphenoidal pituitary adenoma resection commonly utilizes computed tomogram (CT) for immediate postoperative assessment and magnetic resonance imaging (MRI) for follow-up.
- The natural decrease in residual tumor size over time is known, but the quantitative differences between CT and MRI have not been established.
Purpose of the Study:
- To quantify the size difference of residual pituitary adenoma on immediate postoperative CT compared to delayed MRI.
Main Methods:
- Retrospective analysis of 69 patients who underwent pituitary adenoma resection.
- Measurement of sellar and suprasellar diameter and residual mass volume on both immediate postoperative CT and delayed MRI.
Main Results:
- Residual sellar diameter was significantly larger on immediate CT (16.5 mm, 25% reduction) versus delayed MRI (10.6 mm, 52% reduction).
- Suprasellar component was larger on CT (15.5 mm, 26% reduction) compared to MRI (3.3 mm, 84% reduction).
- Postoperative CT showed a 46% volume reduction, while delayed MRI indicated a 71% reduction.
Conclusions:
- Delayed MRI demonstrates a significant reduction in residual mass compared to immediate postoperative CT.
- CT is suitable for immediate postoperative assessment, while delayed MRI is recommended for evaluating surgical success and patient prognostication.
