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The value of immediate postoperative MR imaging following endoscopic endonasal pituitary surgery

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

Although the value of early MR imaging has been justified for microscopic transphenoidal surgery, there is no literature evaluating immediate postoperative MR imaging following endoscopic endonasal resection of pituitary adenomas. We hypothesized that MRI of the pituitary gland performed on the first postoperative day is just as effective at detecting residual disease and/or reconstruction materials as the MRI at 3 months following surgery.

Methods

We retrospectively evaluated 102 consecutive patients who underwent endoscopic endonasal surgery for presumed pituitary adenomas. Sixty-four patients met the inclusion criteria with immediate and 3 months MR imaging. Imaging was evaluated by two sets of observers. The following parameters were assessed: enhancement pattern of the pituitary gland, pituitary stalk, nodular enhancement (residual tumor) or linear enhancement (non-tumoral) and residual reconstruction/packing materials.

Results

Gross total resection of the tumors with no cavernous sinus involvement was achieved in 49 out of 52 (94 %) patients. Eleven out of 12 remaining patients with cavernous sinus invasion had residual cavernous sinus component visible on both immediate and 3 month MR imaging. The pituitary gland, position of stalk, and nasoseptal flap could be identified on both post-operative MRIs in all patients. The sensitivity and specificity for residual tumor detection on immediate MRI was 100 % and 97.9 %, respectively. The kappa index evaluating interobserver agreement for identification of residual tumor and packing/reconstruction material on immediate MR was 0.83 and 0.72 indicating near perfect and substantial agreement, respectively.

Conclusion

Immediate MR imaging performed following endoscopic endonasal resection of pituitary lesions provides accurate and reliable information regarding the presence of residual tumor compared to reconstruction and packing materials.

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Acknowledgments

Portions of this work were presented at the 23rd Annual North American Skull Base Society Meeting. Miami, Florida, February 15–17, 2013.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Stroke and Cerebrovascular Center of New Jersey at Capital Health, Two Capital Way, Suite 456, Pennington, NJ, 08534, USA

    Douglas L. Stofko

  2. Department of Neurosurgery, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA

    Amir R. Dehdashti

  3. Division of Neuroradiology, Geisinger Medical Center, Danville, PA, USA

    Thomas Nickles

  4. Center for Health Research, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA

    Haiyan Sun

  5. Department of Neurosurgery, Temple University School of Medicine, Philadelphia, PA, USA

    Amir R. Dehdashti

  6. Department of Radiology, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA

    Thomas Nickles

Authors
  1. Douglas L. Stofko
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  2. Thomas Nickles
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  3. Haiyan Sun
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  4. Amir R. Dehdashti
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Corresponding author

Correspondence to Douglas L. Stofko.

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Comment

The authors present the value of immediate postoperative MR imaging following endoscopic endonasal pituitary surgery.

In general, the results of this study demonstrate that early MR imaging at 1.5 and 3.0 Tesla is useful to detect tumor remnant after endoscopic pituitary surgery and therefore should be recommended.

Daniel Hänggi

Düsseldorf

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Stofko, D.L., Nickles, T., Sun, H. et al. The value of immediate postoperative MR imaging following endoscopic endonasal pituitary surgery. Acta Neurochir 156, 133–140 (2014). https://doi.org/10.1007/s00701-013-1834-6

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  • DOI: https://doi.org/10.1007/s00701-013-1834-6

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