Correlation of Pituitary Descent and Diabetes Insipidus After Transsphenoidal Pituitary Macroadenoma Resection.

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  • Author(s): Ma J;Ma J; Gooderham P; Akagami R; Makarenko S
  • Source:
    Neurosurgery [Neurosurgery] 2023 Jun 01; Vol. 92 (6), pp. 1269-1275. Date of Electronic Publication: 2023 Jan 18.
  • Publication Type:
    Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Lippincott Williams & Wilkins, Inc Country of Publication: United States NLM ID: 7802914 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4040 (Electronic) Linking ISSN: 0148396X NLM ISO Abbreviation: Neurosurgery Subsets: MEDLINE
    • Publication Information:
      Publication: 2022- : [Philadelphia] : Lippincott Williams & Wilkins, Inc.
      Original Publication: Baltimore, Williams & Wilkins.
    • Subject Terms:
      Pituitary Neoplasms*/surgery ; Pituitary Neoplasms*/pathology ; Pituitary Diseases* ; Diabetes Insipidus*/etiology ; Adenoma*/surgery ; Adenoma*/pathology ; Diabetes Mellitus*; Humans ; Postoperative Complications ; Pituitary Gland/surgery ; Pituitary Gland/pathology ; Retrospective Studies
    • Abstract:
      Background: Endoscopic transsphenoidal surgery remains the technique of choice for resection of pituitary adenoma. Postoperative diabetes insipidus (DI) is most often transient and observed in 1.6% to 34% of patients, whereas permanent DI has been reported in 0% to 2.7% of patients. The proposed mechanism was the transduction of traction forces exerted by the surgeon on the descended diaphragma sellae and through the pituitary stalk.
      Objective: To quantify and correlate the degree of pituitary gland descent with postoperative DI.
      Methods: Of 374 patients who underwent transsphenoidal resection of a pituitary adenoma between 2010 and 2020 at our institution, we report a cohort of 30 patients (Group A) DI. We also report a matched cohort by tumor volume of 30 patients who did not develop DI (Group B). We quantified the tension on the pituitary stalk by calculating pituitary descent interval (PDI) by comparing preoperative and postoperative position of the pituitary gland and using Pythagoras' formula where , with craniocaudal (CC) and anterior-posterior (AP) representing measurements of pituitary translation in respective directions after resection.
      Results: Patients who developed DI had significantly greater pituitary gland translations in the craniocaudal (23.0 vs 16.3 mm, P = .0015) and anteroposterior (2.4 vs 1.5 mm, P = .0168) directions. Furthermore, Group A had a statistically greater PDI, which was associated with development of DI (23.2 vs 16.6 mm, P = .0017).
      Conclusion: We were able to quantify pituitary descent and subsequent tension on the pituitary stalk, while also associating it with development of postoperative DI after pituitary adenoma resection.
      (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
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    • Publication Date:
      Date Created: 20230126 Date Completed: 20230517 Latest Revision: 20231011
    • Publication Date:
      20250114
    • Accession Number:
      10.1227/neu.0000000000002360
    • Accession Number:
      36700759