Morphological Classification of Pituitary Tumors With Suprasellar Extension

Sauradeep Sarkar; C Eduardo Corrales; Edward R Laws Jr; Timothy R Smith

doi:10.1227/neu.0000000000002786

Morphological Classification of Pituitary Tumors With Suprasellar Extension

Neurosurgery. 2023 Dec 4. doi: 10.1227/neu.0000000000002786. Online ahead of print.

Authors

Sauradeep Sarkar^{1

2}, C Eduardo Corrales³, Edward R Laws Jr¹, Timothy R Smith^{1

2}

Affiliations

¹ Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
² Computatonal Neuroscience Outcomes Center, Harvard Medical School, Boston, Massachusetts, USA.
³ Department of Otolaryngology, Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 38047633
DOI: 10.1227/neu.0000000000002786

Abstract

Background and objectives: The objective of this study was to study the association among various morphological parameters and surgical outcomes in pituitary macroadenomas with suprasellar extension.

Methods: MRI studies of 160 patients undergoing endoscopic transsphenoidal resection of pituitary macroadenomas with suprasellar extension were reviewed. In the coronal plane, tumors were classified into Type 1 (dome-shaped, no constriction at the level of diaphragma sellae) and Type 2 (dumbbell-shaped, with constriction at the level of diaphragma sellae). Based on the dome-to-neck ratio (D/Nr), Type 2 tumors were further classified as Type 2A (wide neck; D/Nr >1 and <1.3) and Type 2B (narrow neck; D/Nr ≥1.3). Surgical outcomes and complications were analyzed using a logistic regression model. Overall extent of resection (EOR) and presence of residual sellar-suprasellar tumor was separately assessed in all patients with available postoperative MRI (n = 149).

Results: There were 108 Type 1 tumors and 26 patients each in the Type 2A and Type 2B subgroups. Tumor subtype was significantly associated with tumor size (P < .001), intraoperative cerebrospinal fluid leak (P < .001), EOR (P < .001), postoperative suprasellar residual tumor (P < .001), and postoperative complications, including diabetes insipidus (P = .005) and visual worsening (P = .003). On multivariate analysis, after adjusting for confounders, Type 2B tumors were negatively associated with EOR (odds ratio [OR] 0.22; 95% CI 0.07-0.68; P = .008) and associated with the presence of postoperative suprasellar residual tumor (OR 18.08; 95% CI 5.20-62.89; P < .001), intraoperative cerebrospinal fluid leak (OR 5.33; 95% CI 1.89-14.99; P = .002), and postoperative diabetes insipidus (OR 4.89; 95% CI 1.67-14.35; P < .001).

Conclusion: Preoperative tumor classification based on D/Nr is clinically and surgically relevant, and Type 2B macroadenomas are significantly associated with lower rates of gross total resection and higher rates of postoperative complications after endoscopic transsphenoidal resection.