Journal of Neurological Sciences (Turkish) 2017 , Vol 34 , Num 1
Which is More Predictive in the Extent of Resection of Pituitary Adenomas, Cavernous Sinus Invasion or Preoperative Tumor Volume?
Erhan CELİKOGLU1,Ali Fatih RAMAZANOGLU1,Aycicek CECEN1,Merih İS1,İlker KİRAZ2
1Fatih Sultan Mehmet Training and Research Hospital, Neurosurgery, İstanbul, Turkey
2Ergani State Hospital, Neurosurgery, Diyarbakır, Turkey
Objectives. Pituitary adenoma surgery can be challenging and residual tumor tissue avoids complete recovery. A few studies have explored preoperative tumor volume as a predictor of the presence of a residual tumor besides suprasellar and/or parasellar extension. We aimed to predict the existence of residual tumor by measuring preoperative tumor volume.

Materials and Methods. This retrospective study was performed on 118 patients with pituitary macroadenomas who underwent trans-sphenoidal pituitary surgery in Kartal Lutfi Kirdar Training and Research Hospital between January 2011 and August 2014. We explored the effectiveness and reliability of radiologic variables including preoperative tumor volume and cavernous sinus invasion (Knosp grading) on the presence of residual tumor (thus triggering a need for repeat resection).

Results. The most significant correlation noted was between postoperative residual tumor volume and preoperative Knosp grading (r= 0.800, p<0.001). Also, we recorded a highly significant positive correlation between postoperative residual tumor volume and preoperative tumor volume (r= 0.551, p<0.001). The preoperative tumor cut-off volume for gross total resection was 3.4 cm3.

Conclusion. The most reliable factor predicting a postoperative residual mass was the existence of cavernous sinus invasion. The possibility of gross total resection decreased as the preoperative measured tumor mass exceeded 3.4 cm3. Keywords : Cavernous sinus invasion, pituitary adenoma, suprasellar extension, trans-sphenoidal surgery, tumor volume