Guidance value of MRI for transsphenoidal surgery of pituitary adenomas with cystic degeneration.

Objective: This study is to evaluate the surgical outcomes of transsphenoidal surgery in pituitary adenoma (PA) patients with cystic degeneration by using MRI.

Methods: Eighty-three patients with surgically and pathologically confirmed PA were enrolled. They were divided into three groups according to preoperative MR images: substantive adenoma group (n = 40), cystic degeneration without fluid-fluid level group (n = 19), cystic degeneration with fluid-fluid level group (n = 24). The PA was removed by transsphenoidal surgery and the surgical outcomes were retrospectively compared.

Results: The number of cases with abundant blood supply was 17 cases (42.5%) in substantive adenoma group, 13 cases (68.4%) in cystic degeneration without fluid-fluid level group and 16 cases (66.7%) in cystic degeneration with fluid-fluid level group. Blood supply in cystic degeneration with fluid-fluid level group was significantly richer than that in substantive adenoma group (P < 0.05). Peritumoral adhesion was significantly greater in cystic degeneration with fluid-fluid level group than in substantive adenoma group. And, PA with fluid-fluid level has significantly lower tumor total resection rate and MVD as well as higher recurrence rate (P < 0.05). Differences in cerebrospinal fluid leakage and postoperative diabetes insipidus were both not significant among the three groups (P > 0.05).

Conclusions: Compared with other types of PA, cystic degeneration with fluid-fluid level were often richer in blood supply, greater in adhesion with peritumoral structures and easier to be found with tumor residual. Thus, more patience should be needed during the surgeries and more dynamic reviews are required postoperatively.