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Updated: Jul 3, 2025
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Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
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Development and validation of a prediction model for consistency of pituitary adenoma: the PiTCon score
Alberto Acitores Cancela1,2, Víctor Rodríguez Berrocal3,4, Hector Pian Arias5
1Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain. alacitores@gmail.com.
Acta Neurochirurgica
|February 14, 2024
Summary
Fibrous pituitary adenomas (PAs) are difficult to resect. This study identified clinical and radiological factors to predict fibrous PA consistency preoperatively, developing a scoring system to aid surgeons.
Area of Science:
- Neurosurgery
- Endocrinology
- Oncology
Background:
- Pituitary adenomas (PAs) typically have soft consistency, aiding complete surgical removal.
- A subset of PAs (5-13%) exhibit fibrous consistency, posing surgical challenges and increasing morbidity/mortality.
Purpose of the Study:
- To identify preoperative clinical and radiological predictors of fibrous pituitary adenoma consistency.
- To develop a scoring system for predicting fibrous PA incidence.
Main Methods:
- Analysis of 226 consecutive endoscopic endonasal transsphenoidal resections.
- Application of univariable and multivariable logistic regression.
- Development of a point scoring system (PiTCon) based on predictive factors.
Main Results:
- Five factors accurately predicted PA consistency: age, compressive symptoms, panhypopituitarism, craniocaudal extension, and prior surgery.
- The multivariable model demonstrated strong predictive accuracy (AUC 0.82).
- A validated point scoring system (PiTCon score) was derived.
Conclusions:
- Preoperative estimation of PA consistency is feasible using clinical and radiological data.
- The PiTCon score aids neurosurgeons in clinical decision-making, risk assessment, and patient prognosis.
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