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Quantitative Volumetric Analysis Post Transsphenoidal Pituitary Adenoma Surgery

Published online by Cambridge University Press:  02 December 2014

Alireza Mansouri ,
Sean Symons ,
Michael Schwartz ,
Joseph Chen  and
Farhad Pirouzmand
Alireza Mansouri*
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
Sean Symons
Affiliation:
Division of Neuroradiology, University of Toronto, Toronto, Ontario, Canada
Michael Schwartz
Affiliation:
Division of Otolaryngology - Head and Neck Surgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
Joseph Chen
Affiliation:
Division of Otolaryngology - Head and Neck Surgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada
Farhad Pirouzmand
Affiliation:
Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
*
Division of Neurosurgery, Hospital for Sick Children, 555 University Avenue, Suite # 1503, Toronto, Ontario, M5G 1X8, Canada. Email: alireza.mansouri@utoronto.ca
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Abstract

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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.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 5 , September 2012 , pp. 600 - 604
Copyright
Copyright © The Canadian Journal of Neurological 2012

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