Clinical Implication of the Preoperative Pituitary Gland Estimated Location in Nonfunctional Pituitary Adenoma: A Prospective Study

Introduction: The endoscopic endonasal approach has increasingly favored access to the ventral skull base pathology, particularly for pituitary adenomas resection. Unfortunately, its application is not free of complications. Approximately 5% of patients experience endocrine dysfunction due to damage to the normal pituitary gland or water-electrolyte imbalance due to excessive manipulation, particularly with large macroadenomas.

Objective: To evaluate the implication of preoperative estimation of pituitary gland location in non-functional pituitary adenomas in the surgical, clinical, and endocrinological outcome.

Methods: Ten consecutive patients scheduled for surgery of a non-functional pituitary adenoma were prospectively included. Preoperative MRI sequences (T1+ C and Volumetric Interpolated Breath-hold Examination—VIBE) were analyzed by a senior skull base neurosurgeon to estimate the pituitary gland location. The prediction was recorded in a sellar, suprasellar, or parasellar segmentation panel for posterior correlation purposes. The time employed to predict the gland location, total surgical duration (TSD), intradural surgical duration (ID), and the TSD/ID ratio were measured. Then, the actual gland location was confirmed by intraoperative visualization and neuronavigation assistance; the correlation with preoperative observation was recorded. Demographic and intrinsic tumoral variables and intraoperative-postoperative outcomes were registered and analyzed.

Results: The surgeries were performed by the same skull base surgical team, conformed by two ENT clinical fellows, two senior skull base ENT, and one senior skull base neurosurgeon. In 90%, a transellar EEA was employed; only one case required an extended transtuberculum-transellar EEA. Most of the lesions were macroadenomas (80%); one was a giant adenoma, and one was a microadenoma. Forty percent of the patients included were females. The time employed to predict the gland location was inferior to 2 minutes in 90%. A 70% of positive correlation was observed between the preoperative estimation and the actual gland situation. The intradural surgical time and intraoperative CSF leak events were significantly increased in cases with negative correlation and higher tumoral volume. No differences were observed in the hospital length of stay and early postoperative comorbidity.

Conclusion: Preoperative MRI to estimate the pituitary gland location in non-functional pituitary adenoma is highly correlated with the actual gland location. A negative predictive estimation correlation and higher tumoral volume were associated with increased intradural surgical duration and risk of intraoperative CSF leak. Future studies with larger samples and longer follow-up are needed to confirm our results.

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Artikel online veröffentlicht:
15. Februar 2022