The consistency, or texture, of a pituitary adenoma (PA), is a significant intraoperative trait that can influence the operational dissection procedures and/or equipment utilised to remove the tumour during endoscopic endonasal methods (EEAs). The effect of PA uniformity on surgical outcomes is still unknown. Researchers developed a 5-point grading system for consistency in intraoperative procedures (EEAs) based on intraoperative characteristics, including ease of tumor debulking, manipulation, and instrument selection. The proposed grading system was prospectively assessed in 306 consecutive patients who underwent EEA for PAs.
In a study of 306 individuals who had their PA consistency assessed intraoperatively, there were 214 nonfunctional PAs (69.9%) and 92 functional PAs (31.1%). Grade 4/5 PAs were significantly larger (22.5 vs 26.6 mm) and more likely to have CSI (39 percent vs 42 percent vs 59 percent, p 0.05) than grade 1/2 and grade 3 PAs. Patients with preoperative visual impairment who had a lower PA consistency score had more improvement. Intraoperative CSF leaks were found in 32% of patients, with higher-consistency-grade tumours being more prevalent.
The data show that the suggested intraoperative grading scale is clinically relevant in terms of PA subtype, neuroimaging characteristics, EOR, and endocrine consequences. Future research will look at the relationship between PA consistency and preoperative MRI results in order to better predict consistency. This will enable the surgeon to customise the exposure and plan for different resection tactics.
Reference Link – https://thejns.org/view/journals/j-neurosurg/134/6/article-p1800.xml
