Faculty Collaboration Database

Association between pituitary adenoma consistency, resection techniques, and patient outcomes: a single-institution experience. J Neurosurg 2025 Jun 01;142(6):1674-1681

Date

01/24/2025

Pubmed ID

39854708

DOI

10.3171/2024.8.JNS232715

Scopus ID

2-s2.0-105007102034 (requires institutional sign-in at Scopus site)   9 Citations

Abstract

OBJECTIVE: The present study aimed to investigate the association between pituitary adenoma (PA) consistency and other measurable tumor characteristics, extent of resection (EOR), postoperative complications, and outcomes.

METHODS: In total, 507 PA resections were intraoperatively assigned a consistency grade from 1 (cystic/hemorrhagic tumors) to 5 (calcified tumors) based on intraoperative tumor characteristics. Tumor consistency was analyzed in tertiles (grades 1 and 2, grade 3, and grades 4 and 5) to determine associations with tumor characteristics, EOR, recurrence, postoperative outcomes, and complications.

RESULTS: The cohort in this study included primarily macroadenomas (93.3%) comprised mostly of nonfunctional PAs (NFPAs) (79.5%), with 77.1% showing suprasellar extension, 16.6% showing infrasellar invasion, and 46.4% showing cavernous sinus invasion (CSI). PA consistency grades were as follows: grade 1 or 2 (40.6%), grade 3 (39.3%), and grade 4 or 5 (20.1%). Compared with grade 1 or 2, higher-consistency PAs were more common in men (p = 0.001) and trended toward lower rates of gross-total resection (GTR) (67.6% vs 53.5%, p = 0.06). Higher PA consistency was predictive of any postoperative complication (OR 1.23, 95% CI 1.05-1.43; p = 0.009), specifically including transient diabetes insipidus (DI) (OR 1.45, 95% CI 1.12-1.85; p = 0.004) and cranial nerve (CN) paresis (OR 3.45, 95% CI 1.56-7.69; p = 0.002). Higher consistency was a strong predictor of CN palsy (OR 3.33, 95% CI 1.52-7.30; p = 0.004) for NFPAs. Higher-consistency PAs were more frequently adrenocorticotropic hormone-positive in both univariable (OR 1.33, 95% CI 1.11-1.60; p = 0.002) and multivariable (OR 1.38, 95% CI 1.11-1.69; p = 0.004) analyses. Higher consistency was associated with lower rates of GTR on stratification by CSI for Knosp grade 3 (p < 0.001) and grade 4 (p < 0.001) PAs, but not in low-grade (Knosp grades 1 and 2) PAs.

CONCLUSIONS: Tumor consistency is an important consideration for the resection strategy, particularly for PAs with CSI, and a predictor of intraoperative CSF leaks and perioperative complications and outcomes, including EOR, CN paresis, and transient DI.

Author List

Guerra GA, Kashif Z, Cote DJ, Feng JJ, Renn A, Yang M, Cheok S, Peterson R, Shiroishi MS, Carmichael JD, Zada G

Author

Stephanie K. Cheok MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenoma
Adult
Aged
Female
Humans
Male
Middle Aged
Neurosurgical Procedures
Pituitary Neoplasms
Postoperative Complications
Retrospective Studies
Treatment Outcome
Young Adult