Preoperative Surgical Risk Assessment by Evaluation of Tumor Blood Flow Using Perfusion Imaging by Computed Tomography in Transsphenoidal Surgery for Pituitary Adenoma

Abstract

<jats:title>Abstract</jats:title> <jats:p>Background: Complete removal of large and giant pituitary adenomas (PAs) with suprasellar extension by transsphenoidal surgery (TSS) is sometimes difficult. Swelling and bleeding of a residual suprasellar tumor after incomplete removal via TSS can compress the surrounding neurovascular structures, resulting in postoperative complications. We measured PA blood flow by perfusion computed tomography (PCT) and assessed its usefulness in the preoperative prediction of postoperative hemorrhagic complications after TSS.Method: We performed PCT in 28 patients with PAs with suprasellar extension before TSS. Perfusion studies were performed with a 320-row multidetector computed tomography system. We measured cerebral blood volume (CBV) and cerebral blood flow (CBF) of the tumor (CBVt and CBFt) and normal-appearing white matter (CBVw and CBFw).Results: In all patients, CBVt was greater than CBVw. There was a statistically significant difference between CBFt and CBFw (p &lt; 0.0001). The patients were divided into 2 groups according to CBFt: high CBF (CBFt&gt; mean value) and low CBF (CBFt&lt; mean value). There were no statistically significant differences between the 2 groups in terms of gender, age, maximum tumor diameter, suprasellar extension grade, and extent of resection. Two of the 7 patients in the high CBF group suffered from visual acuity deterioration and visual field stenosis due to postoperative hemorrhage, while no patients in the low CBF group did (p = 0.014).Conclusions: PCT may be useful in the preoperative prediction of postoperative residual tumor hemorrhage, which can be a hazardous postoperative complication after TSS for large and giant PAs.</jats:p>