Clinical outcomes based on intra operative consistency of tumors and Apparent Diffusion Coeffecient Value in Pituitary Macroadenoma Post Endoscopic TNTS Excision

Garg Manish; Sridhar M S; Verma S.; Bhadoria Jitendra

Volume : IX, Issue : I, January - 2019

Clinical outcomes based on intra operative consistency of tumors and Apparent Diffusion Coeffecient Value in Pituitary Macroadenoma Post Endoscopic TNTS Excision

Garg Manish, Sridhar M S, Verma S. , Bhadoria Jitendra

Abstract :

Aim: Pre operative evaluation of tumor consistency of pituitary adenomas is important and is being routinely evaluated radiologically.We have evaluated pre–operatively ADC value derived from MRI and consistency of tumors intraoperatively as per Neurosurgeon and co related with the different post operative outcomes in pituitary adenoma. We have evaluated the outcomes post surgery in relation to the tumor consistency assessed intraoperatively and ADC values. Materials and Methods: 33 cases of Pituitary adenoma had been divided into three groups, according to the intra operative assessment of the consistency of the tumor. Tumors which were easily suckable with suction were grouped as “soft” and the tumors which were fious and could not be removed despite fragmentation and manipulation, and required CUSA(Cavitron Ultrasonic Surgical Aspirator) for resection were grouped as “firm” consistency. Contrast MRI in 3T with diffusion weighted sequences with ADC values was done. All surgeries were performed by a single experienced neurosurgeon. Finally, Fisher probability tests and unpaired t tests were used to compare predictions on the basis of the MR imaging findings with the tumor consistency discovered peroperatively. Results: Statistical analysis revealed that there was no correlation between consistency of tumor with the age, sex, durations of symptoms, tumor size and extension, endocrine dysfunction and post op visual recovery. Findings in this study suggest a predictability between preoperative radiological assessment of consistency and per op tumor consistency of Pituitary macroadenomas at a clear cut off value at 0.681x10(–3) mm(2)/s. Conclusion: Our conclusion is that preoperative ADC values can predict tumor consistency but consistency per se have no statistical relation with different outcomes post surgery.