Medical Scientist Training Program, The Ohio State University College of Medicine, Columbus, OH, USA.
Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10th Ave, Columbus, OH, 43210, USA.
Acta Neurochir (Wien). 2024 Nov 15;166(1):456. doi: 10.1007/s00701-024-06353-y.
Pituitary adenomas are amongst the most common benign central nervous system tumors, and often require resection via an endoscopic endonasal approach (EEA). Two of the most common associated complications are central diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both are thought to be caused by manipulation of the posterior pituitary gland (PPG), making intraoperative visualization and preservation of this structure critical. Intraoperative endoscopic endonasal ultrasound (IEUS) may present an optimal tool for this purpose. This study aims to describe the appearance and morphology of the PPG on IEUS.
This study included all pituitary adenoma surgeries during which IEUS was utilized and the PPG was visualized between 1/1/2022, and 12/31/2023. Demographic, clinical, pathological, and radiological data were retrospectively collected. The PPG was described as either hypoechoic, isoechoic, or hyperechoic as compared to the anterior pituitary gland and adenoma, and the morphology of the PPG was further classified as ellipse or crescent shaped.
The PPG was hypoechoic in all 43 cases included in our final cohort (100.0%). Morphologically, the PPG appeared elliptical in 27 cases (62.8%), and crescent shaped in 16 cases (37.2%).
The PPG can typically be visualized by IEUS as a hypoechoic structure immediately anterior to the posterior wall of the sella turcica, with elliptical morphology being the most common appearance. These characteristics can be used by the skull base surgeon to more confidently identify the position and morphology of the PPG intraoperatively for its' preservation.
垂体腺瘤是最常见的良性中枢神经系统肿瘤之一，通常需要通过内镜经鼻入路（EEA）进行切除。两种最常见的相关并发症是中枢性尿崩症（DI）和抗利尿激素分泌不当综合征（SIADH）。两者都被认为是由于对垂体后叶（PPG）的操作引起的，因此术中可视化和保护该结构至关重要。术中内镜经鼻超声（IEUS）可能是一种理想的工具。本研究旨在描述 IEUS 下 PPG 的外观和形态。
本研究包括在 2022 年 1 月 1 日至 2023 年 12 月 31 日期间进行的所有使用 IEUS 并观察到 PPG 的垂体腺瘤手术。回顾性收集人口统计学、临床、病理和影像学数据。PPG 与前叶垂体和腺瘤相比被描述为低回声、等回声或高回声，并进一步将 PPG 的形态分类为椭圆形或新月形。
在我们最终的队列中，所有 43 例患者的 PPG 均为低回声（100.0%）。形态上，PPG 在 27 例（62.8%）中呈椭圆形，在 16 例（37.2%）中呈新月形。
IEUS 通常可以将 PPG 视为蝶鞍后壁前的低回声结构，椭圆形形态是最常见的外观。这些特征可被颅底外科医生用于更有信心地在术中识别 PPG 的位置和形态，以保护其不受损伤。
