Clival Invasion on Multi-Detector CT in 390 Pituitary Macroadenomas: Correlation with Sex, Subtype and Rates of Operative Complication and Recurrence

Abstract

BACKGROUND AND PURPOSE: Clival invasion, a rare but potentially significant complication of pituitary adenoma, is difficult to detect on MR imaging. Because CT is widely used in adjunct guidance of pituitary surgery and it has recently been suggested that preoperative CT may add useful diagnostic information in addition to pituitary MR imaging, we performed the first large cross-sectional imaging study to define the image attributes, clinical correlates, and prognostic implications of clival invasion on CT for pituitary adenoma surgical guidance.

The Use of Image-Guidance during Transsphenoidal Pituitary Surgery in the United States

“…Preoperative CT imaging has demonstrated a greater ability to identify the lateral tumor margins, sellar floor invasion, and clival invasion when compared directly with MR imaging of pituitary adenomas, which may translate into improved surgical navigation. 21,22 Unfortunately, this database does not include information on the size of lesion, zones of involvement, or revision surgeries, factors that would aid in isolating a more specific correlation to explain this difference in outcomes.…”

Evaluation of the Sellar and Parasellar Regions

“…7 Up to 8.2% of macroadenomas can have clival invasion. 8 An invasive macroadenoma can be either functional or nonfunctional. As a result, if the pituitary gland is not visualized, consider obtaining endocrine laboratory values before surgical biopsy of a clival mass.…”

Benign and malignant diseases of the clivus

“…Clival invasion is significantly more common in women, in patients with large tumours, and in patients with null cell tumours. 48 Attention to the presence of clival invasion on preoperative pituitary guidance CT is warranted. Unlike meningioma, this lesion does not narrow the cavernous carotids.…”