Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Japan.
Pituitary. 2016 Dec;19(6):552-559. doi: 10.1007/s11102-016-0739-9.
Diabetes insipidus (DI) remains a complication of transsphenoidal surgery (TSS) for sellar and parasellar tumors. Antidiuretic hormone (ADH) appears as hyper intensity (HI) in the pituitary stalk and the posterior lobe of the pituitary gland on T1-weighted magnetic resonance (MR) imaging. Its disappearance from the posterior lobe occurs with DI, indicating a lack of ADH. The appearance of HI in the pituitary stalk indicates disturbances in ADH transport.
This retrospective study included 172 patients undergoing TSS for sellar tumors at our institute from 2006 to 2014. Sequential T1-weighted MR images without enhancement were evaluated for HI in the pituitary stalk and the posterior lobe to assess the localization of ADH before and at intervals after TSS. DI was assessed pre- and postoperatively. HI in the pituitary stalk showed the following morphology: (1) ovoid in the distal end of the pituitary stalk (group A), (2) linear in the distal part of the pituitary stalk (group B), (3) linear in the whole pituitary stalk (group C).
Preoperative DI occurred in 6 patients (3.5 %) with no HI observed in the posterior lobe. Postoperative DI was transient in 82 patients (47.7 %), and permanent in 11 (6.4 %). One week after surgery, HI was absent in the posterior lobe in 74 patients (43.0 %), and present in the pituitary stalk in 99 patients (57.6 %); both were significantly correlated with postoperative DI (p < 0.001). The absence of HI in the posterior lobe (A, 48.9 %; B, 68.3 %; C, 92.3 %), persistence of DI (A, 3.7 days; B, 45.9 days; C, 20.5 months), and duration until HI recovery in the posterior lobe (A, 3.6 months; B, 6.8 months; C, 22.9 months) were greatest in group C, followed by group B, and then group A. Fourteen group A patients did not have postoperative DI despite having HI in the pituitary stalk and the posterior lobe. Four group C patients developed permanent DI with persistence HI in the pituitary stalk.
HI in the pituitary stalk and its absence in the posterior lobe indicated postoperative DI, which was transient if HI was detected in the pituitary stalk. DI duration could be predicted by the length of HI in the pituitary stalk, which corresponded to the degree of ADH transport obstruction.
尿崩症（DI）仍然是鞍区和鞍旁肿瘤经蝶窦手术（TSS）的并发症。抗利尿激素（ADH）在 T1 加权磁共振（MR）成像上表现为垂体柄和垂体后叶的高信号（HI）。DI 时，后叶的 ADH 消失，表明 ADH 缺乏。垂体柄中的 HI 表明 ADH 转运受损。
本回顾性研究纳入了 2006 年至 2014 年在我院行 TSS 治疗鞍区肿瘤的 172 例患者。对无增强 T1 加权 MR 图像进行评估，以评估垂体柄和后叶 ADH 的 HI，以评估 TSS 前后 ADH 的定位。术前和术后均评估 DI。垂体柄 HI 显示以下形态：（1）垂体柄末端卵圆形（A 组）；（2）垂体柄远端线性（B 组）；（3）整个垂体柄线性（C 组）。
术前 6 例（3.5%）发生 DI，后叶未见 HI。82 例（47.7%）术后发生一过性 DI，11 例（6.4%）为永久性 DI。术后 1 周，74 例（43.0%）后叶 HI 缺失，99 例（57.6%）垂体柄 HI 存在，两者均与术后 DI 显著相关（p<0.001）。后叶 HI 缺失（A 组 48.9%，B 组 68.3%，C 组 92.3%）、DI 持续存在（A 组 3.7 天，B 组 45.9 天，C 组 20.5 个月）和后叶 HI 恢复时间（A 组 3.6 个月，B 组 6.8 个月，C 组 22.9 个月）均以 C 组最大，其次是 B 组，然后是 A 组。14 例 A 组患者虽有垂体柄和后叶 HI，但术后无 DI。4 例 C 组患者出现永久性 DI，垂体柄 HI 持续存在。
垂体柄 HI 及其后叶 HI 缺失提示术后 DI，如垂体柄 HI 存在则为一过性 DI。DI 持续时间可通过垂体柄 HI 长度预测，与 ADH 转运受阻程度相对应。
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