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Updated: Sep 10, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
The utilization of preoperative DWI for pituitary macroadenoma surgical planning: Implications for neuroendoscopic
1The Affiliated Hospital of Xuzhou Medical University, Department of Neurosurgery, Xuzhou, Jiangsu, China.
Purpose:
The consistency of pituitary adenomas (PAs) significantly influences the success of complete tumor resection, which is crucial for prognosis in patients. The aim of this study is to use preoperative diffusion-weighted imaging (DWI) to evaluate tumor consistency, thereby assisting surgeons in achieving optimal resection outcomes during neuroendoscopic procedures.
Methods:
We collected clinical data (including age, sex, symptoms, and consistency), pathological data (including collagen content), and imaging data (including tumor size and ADC ratio) from 264 patients with pituitary macroadenomas. Patients were categorized based on intraoperative consistency assessments and postoperative resection rates to analyze the efficacy of DWI in predicting consistency and identifying determinants of the completeness of resection. Correlation analysis and multiple linear regression were used to explore the relationships among the ADC ratio, tumor consistency, and collagen content. Logistic regression was applied to analyze the factors influencing tumor resection.
Results:
This study included 264 patients. There were 202 patients with a soft consistency and 62 patients with a hard consistency. A total of 212 patients achieved complete resection. The median ADC ratio for the soft consistency group was 1.27 [1.04, 1.59], and that for the hard consistency group was 0.89 [0.83, 0.94] (P < 0.05). The median collagen content in the soft group was 4.55 [2.13, 6.69], and that in the hard group was 13.91 [10.30, 19.20] (P < 0.05). The ADC ratio was significantly related to the collagen content (ρ = -0.965; 95% CI: -0.973 ~ -0.955; P < 0.05). The ADC ratio was a significant predictor for achieving gross-total tumor resection (OR: 5.714; 95% CI: 1.032-31.628; P < 0.05).
Conclusion:
For most patients with pituitary macroadenomas, neuroendoscopic transsphenoidal surgery is the first-line treatment. Preoperative apparent diffusion coefficient (ADC) ratios obtained from diffusion-weighted imaging (DWI) can help to evaluate tumor consistency and collagen content, thus guiding neurosurgeons in predicting resection ability under neuroendoscopy and thereby improving preoperative assessments for these patients.
