Prolactin-secreting pituitary adenomas: correlation of radiographic and surgical findings

The preoperative hypocycloidal sellar tomograms, angiograms, and pneumoencephalograms of 100 patients being evaluated for prolactin-secreting pituitary adenomas were reviewed and the results correlated with surgical findings at transsphenoidal exploration. The majority (53%) of tumors encountered were microadenomas. Although sellar volume was normal in 72%, sellar shape on tomography was abnormal in 96%; the location of the tumor within the sella could be predicted by means of tomography alone in 88%. Low volume pneumoencephalography was a reliable method for determining suprasellar extension in 19% of cases and in demonstrating arachnoidal diverticulae in 24%, a finding of great importance to the surgeon planning a transsphenoidal exploration. The use of internal carotid angiography to predict lateral tumor extension proved unreliable. Tumor blush was demonstrated only in larger lesions. No vascular anomalies that would contraindicate transsphenoidal exploration were encountered in this group of patients with hyperprolactinemia.