Pituitary stalk changes on magnetic resonance imaging following pituitary adenoma resection using a transsphenoidal approach

• Published in: Frontiers in Neurology
• Main Authors: Huijian Zhang, Shuai Zhang, Mingchao Shang, Jiaxing Wang, Liangfeng Wei, Shousen Wang
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2023-01-01
• Subjects: diabetes insipidus; microsurgery; neurohypophysis; pituitary adenoma (PA); pituitary stalk; transsphenoidal surgery
• Online Access: https://www.frontiersin.org/articles/10.3389/fneur.2023.1049577/full

ObjectiveWe aimed to investigate the magnetic resonance imaging (MRI) findings and clinical significance of position and changes in morphology of the pituitary stalk following pituitary adenoma (PA) resection using a transsphenoidal approach.MethodsWe collected clinical and MRI data of 108 patients with PA after transsphenoidal surgery. Diameter, length, and coronal deviation of the pituitary stalk were measured pre-, post-, and mid-term post-operatively, to observe pituitary stalk morphology.ResultsOf 108 patients, 53 pituitary stalks were recognisable pre-operatively. The angle between the pituitary stalk and the median line was 7.22°-50.20° (average, 25.85°) in 22 patients with left-sided pituitary stalks and 5.32°-64.05° (average, 21.63°) in 20 patients with right-sided pituitary stalks. Of 42 patients with preoperative pituitary stalk deviation, 41 had an early postoperative recovery and 1 had increased deviation. In the mid-term postoperative period, 21 of 42 patients had pituitary stalks located centrally. In 53 patients, the pituitary stalk length was 1.41–11.74 mm (mean, 6.12 mm) pre-operatively, 3.61–11.63 mm (mean, 6.93 mm) in the early postoperative period, and 5.37–17.57 mm (mean, 8.83 mm) in the mid-term postoperative period. In the early postoperative period, 58 (53.70%) patients had posterior pituitary bright spots (PPBS) and 28 (25.92%) had diabetes insipidus (DI).ConclusionPre-operatively, the pituitary stalk was compressed and thinned. Post-operatively, it could be stretched to a “normal state”, and its position showed a gradual centring trend. Post-operatively, the length of the pituitary stalk gradually increased. The PPBS in the early postoperative period negatively correlated with postoperative DI.