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Predicting Arachnoid Membrane Descent in the Chiasmatic Cistern in the Treatment of Pituitary Macroadenoma

Journal of Korean Neurosurgical Society 2021년 64권 1호 p.110 ~ 119
고학철, 이승환, 신희섭, 고준석,
소속 상세정보
고학철 ( Ko Hak-Cheol ) - Kyung Hee University College of Medicine Kyung Hee University Hospital at Gangdong Stroke and Neurological Disorders Centre
이승환 ( Lee Seung-Hwan ) - Kyung Hee University College of Medicine Kyung Hee University Hospital at Gangdong Stroke and Neurological Disorders Centre
신희섭 ( Shin Hee-Sup ) - Kyung Hee University College of Medicine Kyung Hee University Hospital at Gangdong Stroke and Neurological Disorders Centre
고준석 ( Koh Jun-Seok ) - Kyung Hee University College of Medicine Kyung Hee University Hospital at Gangdong Stroke and Neurological Disorders Centre

Abstract


Objective: Preoperative prediction of the arachnoid membrane descent in pituitary surgery is useful for achieving gross total removal and avoiding cerebrospinal fluid leakage resulting from tearing of the arachnoid membrane in the chiasmatic cistern. In this study, we analyzed the patterns of arachnoid membrane descent during or after pituitary tumor surgery and identified the factors related to this descent.

Methods: Analysis was restricted to pituitary macroadenomas not extending into the third ventricle or over the internal carotid artery. To minimize confounding factors, patients who underwent revision surgery, those who had a torn arachnoid during operation or small medial diaphragma sellae (DS) opening, and subtotal resections were excluded. We enrolled 41 consecutive patients in this retrospective analysis. The degree of arachnoid descent was categorized using intraoperative videos. Preoperative magnetic resonance findings, including tumor height, suprasellar extension, and variables including DS area and medial opening size, tumor composition, and displacement of the pituitary stalk and gland were evaluated to determine their correlations with arachnoid membrane descent.

Results: Arachnoid membrane descent was significantly correlated with DS area and medial opening size. Based on T2-weighted images (T2WI) magnetic resonance (MR) images, tumor composition was significantly associated with arachnoid membrane descent. Other factors were not significantly correlated with arachnoid membrane descent.

Conclusion: T2WI of tumor composition and preoperative MR imaging of DS area and medial opening provided valuable information regarding arachnoid membrane descent. These parameters may serve as fundamental measures to facilitate complete resection of pituitary macroadenomas.

키워드

Pitutiary neoplasm; Pituitary adenoma; Diaphragma sellae; Arachnoid mater; Medial opening

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