Transsphenoidal hypophysectomy: postsurgical CT findings

Dolinskas, CA; Fa, Simeone

doi:10.2214/ajr.144.3.487

Cited by 12 publications

(8 citation statements)

References 7 publications

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“…The complete resection of pituitary macroadenomas, especially those with parasellar invasion is not always attainable 9 . The inability of the immediate postoperative CT to accurately assess for residual tumor has been described previously 6,10 . More recent studies have demonstrated the advantage of MRI in detecting residual pituitary adenomas, given its ability to distinguish residual tumor from hemorrhage and packing material used intraoperatively 7,11 ; nonetheless, it is not always easy to distinguish tumor from hemorrhage and fat packing even on MRI.…”

Section: Discussionmentioning

confidence: 99%

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Quantitative Volumetric Analysis Post Transsphenoidal Pituitary Adenoma Surgery

Mansouri

Symons

Schwartz

et al. 2012

Can. J. Neurol. Sci.

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Pituitary adenomas comprise 10% of all surgically-resected intracranial tumors 1 . The overall age-adjusted incidence is about 0.9/100,000 person-years 2 . These tumors can be resected from a variety of approaches, of which the trans-sphenoidal method is the most common and has the lowest complication rate 3 . There are variations in the trans-sphenoidal approach, mainly differing in the access to the sphenoid sinus or visualization technique used during resection.At our institution, computed tomogram (CT) imaging is used to monitor the progress of pituitary tumors preoperatively. Magnetic resonance imaging (MRI) is used prior to surgical ABSTRACT: Background: Computed tomogram (CT) imaging is often used for immediate postoperative assessment of transsphenoidal pituitary adenoma resection while magnetic resonance imaging (MRI) is used for follow-up. The residual mass is known to decrease in size over time but the difference between the two imaging modalities has not been quantified. Our objective was to quantify the size difference of the residual mass on immediate postoperative CT compared with delayed MRI. Methods: Retrospective analysis of 69 patients who had undergone pituitary adenoma resection at our institution between 2004-2010. Sellar and suprasellar diameter, along with the overall volume of the residual mass were measured on both the immediate postoperative CT and delayed MRI. Results: Average preoperative sellar and suprasellar diameter was 22.2 ± 4.6mm and 20.9 ± 5.9mm, respectively. Average sellar residual diameter on immediate postoperative CT (16.5 ± 5.4 mm, 25% reduction) was significantly larger than delayed MRI (10.6 ± 6.2mm, 52% reduction). The average suprasellar component on CT (15.5± 6.5mm, 26% reduction) was also significantly larger than that on MRI (3.3 ± 5.4 mm, 84% reduction). The postoperative CT showed a 46% reduction in volume while a 71% reduction was noted on the delayed MRI. Conclusion: A significant reduction in residual mass is noted on delayed MR imaging compared with immediate postoperative CT. Therefore, from a resource management and prognostication point of view, CT should be used for immediate postoperative assessment while delayed MRI should be used to assess operative success and for communication with patients.RÉSUMÉ: Analyse volumétrique quantitative après la chirurgie par voie transsphénoïdale pour un adénome pituitaire. Contexte : la tomodensitométrie est souvent utilisée pour l'évaluation du résultat de la résection transsphénoïdale d'un adénome pituitaire immédiatement après la chirurgie alors que l'imagerie par résonance magnétique (IRM) est utilisée pour le suivi de ces patients. On sait que la masse résiduelle de la tumeur diminue avec le temps, mais la différence entre les deux techniques d'imagerie n'a pas été quantifiée. Notre objectif était de quantifier la différence de taille de la masse résiduelle entre la tomodensitométrie effectuée immédiatement après la chirurgie et l'IRM effectuée par la suite. Méthode : Nous avons effectué une analyse rétrospective...

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Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging can help distinguish residual tumor from hemorrhage, edema, or hemostatic packing material such as gel foam, muscle or fat plugs 6,7 . A small study by Rodriguez et al has shown that the aforementioned components contribute to the apparent enlargement of the sellar mass that is seen in the first postoperative week.…”

mentioning

confidence: 99%

Quantitative Volumetric Analysis Post Transsphenoidal Pituitary Adenoma Surgery

Mansouri

Symons

Schwartz

et al. 2012

Can. J. Neurol. Sci.

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“…Previous studies documenting the MRI appearances following TSS for pituitary macroadenomas have shown that the majority of patients have partially or completely opacified sphenoid sinuses in the early postoperative period 3,6 . This is due to a combination of surgical packing material, post surgical debris, blood and fluid 3,5,6,16 . During the first year after operation there is a trend towards repneumatization with 60–80% of sinuses being completely aerated within 9–12 months 3,5 .…”

Section: Discussionmentioning

confidence: 99%

“…Magnetic resonance imaging signal abnormality within the other paranasal sinuses was less frequent than that in the sphenoid sinus. Opacification of the maxillary and ethmoid sinuses due to resection of bony septa during TSS usually disappears early 16 and therefore late changes are not related to surgery. Late inflammatory changes in the sphenoid sinus are probably due to blocking of the spheno‐ethmoidal recess, which is distant from most of the other paranasal sinus ostia, and thus is unlikely to be associated with obstructive disease of these sinuses.…”

Section: Discussionmentioning

confidence: 99%

“…3,6 This is due to a combination of surgical packing material, post surgical debris, blood and fluid. 3,5,6,16 During the first year after operation there is a trend towards repneumatization with 60-80% of sinuses being completely aerated within 9-12 months. 3,5 We found a high incidence (26%) of major sphenoid sinus abnormalities, including filling, partial filling and masses protruding into the sinus roof, The T1 signal of indeterminate sphenoid sinus abnormalities was similar to that exhibited by the subsellar tumour in four of six cases.…”

Section: Discussionmentioning

confidence: 99%

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MRI appearances of the sphenoid sinus at the late follow‐up of trans‐sphenoidal surgery for pituitary macroadenoma

Connor

Deasy

2002

Australasian Radiology

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We aimed to demonstrate the appearances of the sphenoid sinus on MRI performed later than 2 years post- transsphenoidal surgery (TSS). We retrospectively reviewed 47 patients in whom follow-up MRI scans had been performed at least 2 years post-TSS. We specifically reviewed the clinical and imaging of those patients in whom the sphenoid sinus was filled with signal abnormality or masses were present arising from the sinus roof and classified them as tumour or indeterminate abnormalities on imaging criteria. We documented other clinicoradiological details. Twelve of 47 patients demonstrated sphenoid sinus filling or sinus roof masses and in six of 12 patients it was possible to classify them as tumourous using imaging and clinical criteria. The indeterminate and non-tumourous sphenoid sinus abnormalities most frequently had a T1-weighted signal similar to subsellar tumour and displayed rim enhancement and thus could not be reliably distinguished from tumourous abnormality on the basis of signal or enhancement characteristics. The presence of a well-defined surgical defect in the sella floor was associated with resolution of abnormality on MRI follow-up. We concluded MRI findings of sphenoid sinus filling or sinus roof masses are present in approximately 26% of scans performed longer than 2 years post-TSS. Half of these are of indeterminate origin and follow-up is required to discriminate tumour from non- tumour with certainty. A well-defined surgical defect in the sella floor is, however, suggestive of a non-tumourous abnormality.

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Postoperative controls in surgically treated hormonactive pituitary adenomas by use of Magnetic Resonance Imaging

Oeckler

Fink

1987

Acta neurochir

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The search of reliable imaging methods to detect the substrate for persisting hypersecretion in patients operated on for hormonactive pituitary adenoma prompted us to study the possibilities of the newly available Magnetic Resonance Imaging (MRI) technique in this regard. Pre- and postoperative MRI-studies where performed in 5 patients with persisting GH excess following transsphenoidal surgery as well as in 3 patients with micro- and 2 patients with macroprolactinomas. The MRI-findings were correlated with the results of the endocrinological examinations. Two acromegalic patients and three cases with microprolactinomas, who were successfully operated upon as defined by the functional criteria were also included to obtain a baseline for normal postoperative findings. The MRI-study was positive in all of the five patients with persisting GH-overproduction. In prolactinomas, the substrate of hypersecretion could only be detected, when the PRL-value exceeded 2,000 microU/ml. MRI may present an important diagnostic method for evaluating further treatment options in patients with remaining hormonal hypersecretion following transsphenoidal adenomectomy, particularly with regard to a second surgical approach.

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Transsphenoidal hypophysectomy: postsurgical CT findings

Cited by 12 publications

References 7 publications

Quantitative Volumetric Analysis Post Transsphenoidal Pituitary Adenoma Surgery

Quantitative Volumetric Analysis Post Transsphenoidal Pituitary Adenoma Surgery

MRI appearances of the sphenoid sinus at the late follow‐up of trans‐sphenoidal surgery for pituitary macroadenoma

Postoperative controls in surgically treated hormonactive pituitary adenomas by use of Magnetic Resonance Imaging

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