The role of preoperative MRI in endoscopic transnasal transsphenoidal hypophysectomy of pituitary adenoma.

BACKGROUND: The trans-sphenoidal approach, commonly used for removing pituitary adenomas, has become a widely accepted and successful method. In recent years, the endoscopic trans-sphenoidal technique has emerged as a minimally invasive surgical approach for pituitary adenoma removal. The majority of pituitary adenomas exhibit a soft consistency and can be successfully extracted with aspiration and curettage using the trans-sphenoidal approach. However, a subset of around 5-15% of these adenomas possess a solid and fibrous texture. The occurrence of firm and fibrous adenomas is relatively common; unfortunately, there are no reliable predictors to identify them preoperatively. OBJECTIVES: The ability to forecast the reliability of magnetic resonance imaging (MRI) holds promise for improving prior preparation and impacts the extent of resection. DESIGN: A cross-sectional analysis of the investigation of magnetic resonance imaging (MRI) in relation to cancer histology was performed on 68 patients who had endoscopic trans-nasal excision for nonfunctional adenomas. MATERIALS AND METHODS: The determination of an intensity ratio was performed by employing quantitative estimates of MRI signal intensity obtained from both the adenoma and pons. During the surgical procedure, a series of sequential-graded procedures were used for the removal of tumours with varying consistencies. Softer tumours were addressed using the Suction technique (R1), while tumours of intermediate consistency were treated using curettes (R2). In order to evaluate the fibrotic content of firmer tumours, the utilization of Cavitron Ultrasound Surgical Aspirator (CUSA), and/or other micro-instruments (R3) was employed, with the histologic collagen fraction being quantified. In order to investigate and analyse the data, a statistical analysis was conducted. A predictive relationship between resection category and both intensity ratio, and collagen percentage was noted. The primary objective of this study was to determine the appropriate cutoff criteria for clinical utilization, as well as to investigate the association between intensity ratios and collagen percentage. RESULTS: Tumors with ratios ≤ 1.6 on the T2-weighted image and collagen content > 5.3% required more meticulous and sharp dissection for resection. CONCLUSIONS: The utilization of MRI analysis may offer some assistance, but not conclusive, in the prediction of tumour consistency.

Preservation versus resection of middle turbinate in endoscopic transnasal transsphenoidal pituitary surgery.

BACKGROUND: The strategic position of the middle turbinate (MT) within the nasal cavity makes it the first kick start to resect pituitary pathology through Endoscopic Transnasal Transsphenoidal Surgery (ETTS). This research aimed to determine if the type of endonasal endoscopic approach, MT resection (MTres) versus MT preservation (MTpre), for pituitary surgery affects olfaction and sinonasal function within a subjective as well as objective manner. PATIENTS & METHODS: A prospective cohort comparative study was conducted to compare the sinonasal and olfaction outcomes pre and post operatively for both groups. Sinonasal symptoms were evaluated subjectively by Sino-Nasal Outcome Test (SNOT-22), while objectively by Peri-Operative Sinus Endoscope Score (POSE) along with Lund-Mackay radiological scoring system (LMS), and a Sniffin Sticks Identification test (SIT) (Burghart, Germany) was used to measure the olfaction intensity. In both groups were used on a pre-operative period and after one, three, and six months post operatively. RESULTS: 96 patients were recruited within predetermined criteria. It is found that there are no significant differences in SIT between both groups with a ρ value 0.439 post operatively. The average change in score (delta) was an increase of 0.3, with changes ranging from -3 to +4. There was no significant difference in sinonasal symptoms score among both groups, with ρ 0.07 posts operatively. There was a minor upsurge in POSE score and LMS in the preservation group but without remarkable differences with ρ value 0.1 and 0.2 subsequently. It is found that there are no significant differences in SIT between both groups with a ρ value 0.439 post operatively. CONCLUSION: Despite these amendments to the nasal cavity, we approved that these changes do not affect the sinonasal functions.