NIMG-101. EVALUATING THE VALIDITY OF EVIDENCE-BASED AANS/CNS GUIDELINES FOR POST-OPERATIVE TIMING OF IMAGING IN PATIENTS WITH NON-FUNCTIONAL PITUITARY ADENOMAS: A PRELIMINARY STUDY IN A COHORT OF PATIENTS

Abstract

INTRODUCTION: Non-Functional Pituitary Adenomas (NFPA) are the most common pituitary tumors. Due to lack of hormonal hypersecretion imaging is the main follow-up modality, especially after surgical treatment. Recent evidence-based guidelines recommend the first postoperative MRI be performed no earlier than 3 months to provide the most meaningful information for extend of resection and for cost effectiveness. METHOD(S): We retrospectively reviewed 28 cases of NFPA treated surgically in our institution that were designated to receive their first postoperative imaging at 3 months with the aim to identify factors that led to earlier imaging and whether late imaging was related to unexpected events. RESULT(S): Twenty-eight patients underwent surgical treatment for NFPA. Twenty-seven underwent transsphenoidal resection and one open craniotomy. Seventeen (60%) were male and 11 (40%) female. Size of tumor ranged from 11mm to 50mm by the largest diameter. MRI of the pituitary gland was performed at or after 3 months post-surgery in all, but 6 patients (21%) who received it on post-operative day 1. Thirteen patients (46%) received CT of head within 1 - 30 days post-operatively (mostly for complains of headache). CT of head did not show any significant abnormality. All patients, but 4 were noticed to have no residual tumor on MRI after 3 months post-operatively. For 6 patients that received MRI on post-operative day 1, we found difficult to determine the amount of residual tumor when compared to MRI at 3 months. One patient underwent exploration transsphenoidal surgery for questionable rhinorrhea. CONCLUSION(S): The majority of the patients in our cohort received their first imaging after 3 months post-operatively as recommended by the AANS/CNS guidelines. No unexpected events were noticed. The timing of the MRI did not change treatment plans. We conclude that following evidence-based guidelines for the first post-operative imaging is safe and certainly more cost effective.