Correlation between the preoperative MR-assessment of the pituitary adenoma’s consistency and the intraoperative condition during transsphenoidal removal

The objective was to identify preoperative neuroimaging parameters that predict the consistency of pituitary adenoma intraoperatively and determine further treatment tactics.

Material and methods. A clinical study of 75 patients with a histologically confirmed diagnosis of pituitary adenoma was conducted. The average age was 51.3±14.8 years, the median was 52 (37/65) years. Preoperative diagnosis was based on clinical and laboratory data, the results of neuroimaging research methods. The study analyzed neuroimaging predictors of adenoma consistency in the preoperative period, with subsequent confirmation intraoperatively. Intraoperative interpretation of tumor density was based on the classification of Rutkowski M.J. (2020).

Results. Transsphenoidal access with endoscopic assistance was used for all the studied patients. Radical removal was performed in 89.3 % of cases (N=67), subtotal removal in 10.7 % (N= 8). In all subtotally operated patients, after 3–6 months, continued tumor growth was observed in MRI monitoring, which in a number of patients required repeated transsphenoidal removal of the sac (in 9.4 %), and in 1.3 % – transcranial removal (through lateral supraorbital access). There was no correlation with histological subtypes of the tumor and the level of ki-67. During the intraoperative analysis, the soft consistency of pituitary adenoma was predominantly found (74.7 %), medium and dense consistency was less common (10.7 and 13.3 %, respectively). T1-isotensive signal may be a predictor of intraoperatively milder pituitary adenoma density (r=0.383; p=0.02). Hyperintensivity of the T2 signal only in combination with elevated values of hypocoagulation markers (PTT and INR) may indicate a soft density of pituitary adenoma (p<0.04).

Conclusions. Predicting tumor consistency at the preoperative stage is an important factor in planning surgical tactics, but not the only one. The prognosis of a dense tumor structure combined with an assessment of its invasiveness – laterosellar growth into the cavernous sinus (Knosp 3–4), suprasellar spread into the structures of the hypothalamus, ventricular system (Hardy 3–4), may preoperatively indicate a high probability of continued growth, the expediency of transcranial removal of the tumor, the timing of follow-up examinations, the need for radiosurgical treatment.

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