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Updated: Jul 2, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
A Grading System Based on Multiparametric Magnetic Resonance Imaging-Predicted Tumor Perfusion, Invasiveness, and
Shun Yao1, Wenting Rui2, Jinming Yang2
1Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China.
Objective:
To develop and validate a novel grading system (Grading system Of 4-Level assessing Difficulty of Surgery based on Perfusion, Invasiveness, and Texture [GOLDS-PIT]) for assessing surgical difficulty based on multiparametric magnetic resonance imaging (MRI)-predicted perfusion, invasiveness, and texture in patients with pituitary macroadenomas (PMAs).
Methods:
Preoperative multiparametric MRI scans were prospectively collected from 240 patients (cohort A) with PMAs to construct a radiomics model predicting tumor perfusion and morphologic-radiomic model predicting texture. The GOLDS-PIT based on multiparametric MRI-predicted tumor perfusion, invasiveness, and texture was then developed with cohort A and validated with another 162 cases of internal cohort B.
Results:
The areas under the curve of the radiomics model predicting tumor perfusion and morphologic-radiomic model predicting texture in the validation cohort were 0.906 and 0.908, respectively. A 16-score GOLDS-PIT stratified surgical difficulty into low, medium, high, and extremely high categories. In the validation cohort, combined approaches were selected in more patients in extremely high and high difficulty groups, which was significantly higher than low and moderate difficulty groups (33% vs. 1%; P < 0.001). These groups had a lower gross total resection rate (84% vs. 46%; P < 0.001), higher severe complication rate (50% vs. 19%; P < 0.001), and higher surgical resource consumption: intraoperative blood loss (600 mL [363-1425] vs. 300 mL [200-400]; P < 0.001), operative duration (5.9 hours [4.0-7.0] vs. 3.0 hours [2.5-4.0]; P < 0.001), and hospitalization cost (¥96,433 vs. ¥67,264; P < 0.001).
Conclusions:
We developed and validated a novel surgical difficulty grading system for PMAs, which can assist surgeons in surgical planning and anticipating surgical outcomes, providing a practical reference for determining appropriate resection strategies.
