Post-operative imaging assessment of non-functioning pituitary adenomas

Background There is no consensus regarding the management and postoperative follow-up of non-functioning pituitary adenomas (NFAs) in the setting of recurrent or residual disease. Subsequent treatment options include continued follow-up, re-resection or radiotherapy. To address this gap and better understand current practice patterns, we surveyed neurosurgeons and radiation oncologists in Canada. Methods Neurosurgeons and radiation oncologists (ROs) across Canada were invited to complete a standardized online questionnaire. Summary statistics were computed, and Fisher's Exact tests were performed to assess significance. Qualitative analyses were performed through open and axial coding. Results Thirty-three participants completed the questionnaires, with neurosurgeons representing a majority of respondents ( n = 20 vs n = 13). When treating giant (>3 cm) tumors, 90.9% of neurosurgeons in practice for less than 10 years reported using an endoscopic approach, as compared to only 66.7% of neurosurgeons in practice for 10 years of more. Additionally, neurosurgeons who were newer to practice had a greater tendency to advocate for stereotactic radiosurgery (SRS) or re-resection (54.5% and 36.4%, respectively), as compared to older surgeons who showed a higher propensity (22.2%) to advocate for observation. The presence of cavernous sinus extension appeared to encourage ROs to offer radiotherapy sooner (61.4%), as compared to 40% of neurosurgeons. Conclusions Our results identified both variations and commonalities in practice amongst Canadian neurosurgeons. Approaches deviated in the setting of residual tumor based on years of practice. This work provides a critical foundation for future studies aiming to define evidence-based best practices in the management of NFAs.

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Surveillance Imaging Strategies for Pituitary Adenomas: When, How Frequent, and When to Stop

Yuen,

Ghalib,

Buchfelder

et al. 2024

Endocrine Practice

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Post-operative imaging assessment of non-functioning pituitary adenomas

Abstract: Post-operative imaging appearance of the pituitary gland, optic apparatus, and pneumocephalus patterns, correlated with the clinical outcomes. Long-term, lifetime follow-up is warranted for NFA patients who underwent surgical resection.

Cited by 5 publications

References 34 publications

Diffusion-weighted imaging for predicting tumor consistency and extent of resection in patients with pituitary adenoma

Diffusion-weighted imaging for predicting tumor consistency and extent of resection in patients with pituitary adenoma

Practice patterns in the management of recurrent and residual non-functioning pituitary adenomas: Results from a Canada-wide survey

Surveillance Imaging Strategies for Pituitary Adenomas: When, How Frequent, and When to Stop

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