Pituitary Macroadenoma Post Surgery MRI Report

[Arun7987]

My father aged 73 was diagnosed with Pituitary Macroadenoma and underwent surgery two months ago. He was advised to undergo a MRI Contrast Scan two months post the surgery.

The results of the investigation are as follows -:
The study reveals post operative changes with dehiscence of the sellar floor on the left side. Large residual/recurrent mass lesion is seen in the sella causing balooning of the sella and extending anteriorly into the presellar region. It is appearing isointense on T1 and T2W images and is showing intense heterogeneous enhancement on the post contrast   images. It is also extending superiorly upto the suprasellar cistern and is closely abutting the optic chiasm and bilateral optic nerves. Laterally mass is extending into the bilateral cavernous sinuses and closely abutting cavernous part of both internal carotid artery with preserved flow void. Peripherally enhancing T2 Hyperintense collection is seen to the sphenoid sinus.

Non specific T2/FLAIR hyperintense foci are seen in deep white matter of the bilateral fronto-parietal region.

Brain parenchyma shows mild diffuse volume loss with prominent extra axial spaces and lateral ventricles.

"Rest of the report states everything is normal"

What does the above mean in layman's terms and what further course of action should be considered??

[rumpled]

Yes, the proximity to that anatomy means radiation. Do research on the types of radiation. There are pros and cons - Gamma is older and while one shot treatment is convenient, well... if you read around here, you can see some people have had trouble afterward. Cyber knife is newer - and has a slightly better accuracy (which may be a factor since you are dealing with not one but two sensitive areas) but it takes quite a few visits and requires a mask so if he has problems with confined spaces, that may be an issue. I am not familiar with the last type myself.

I am only a patient myself - but I had a couple of pituitary tumors and I am facing radiation as my next step (trying to avoid it). If you have the option, proton beam is the most sparring of healthy tissue - but the most expensive.

In the brain tumor/pituitary tumor patient forum (I am CL there) you can find links in the health pages that may help you as well as other patients who have had radiation there.

[Arun7987]

Thank you for your quick and detailed response.

I do understand that Time is of the essence because of which we made it a point to visit the surgeon for a follow up consultation yesterday itself. As for the surgeon, he is reckoned to be one of the eminent neurosurgeons here in South Asia. He has been felicitated with numerous awards and honours in the same field.

What was pointed out during the consultation was the fact that although a major part of the tumour was removed, there remained a significant portion which cannot be removed via the conventional surgical approach due to its proximity to the optic nerve and carotid arteries. The only way forward was through radiotherapy which would considerably shrink the size of the tumour. He suggested that the radiotherapy would last approximately 6 weeks from the date of commencement. Further course of action would depend on the Oncologist of what he/she suggests
Gamma Knife
Cyber Knife
Novalis TX

I will try and upload the images of the MRI before and after surgery to better illustrate my father's condition.

[rumpled]

It looks like your father's surgery either was not very successful or the tumor has grown back very quickly. The tumor is growing up near the optic nerve (part of that is inoperable anyway) and it is also extending near the artery there but not interfering with blood flow (yet).

The *volume loss* if I guess right as a layman, has to do with age - that is normal loss with age unless the loss is outside the normal parameters.

He needs to get back to his pituitary surgeon ASAP - and since that one seems to be a big one - I hope he has a very experienced and very skilled surgeon.