J Korean Neurosurg Soc.  2020 Jul;63(4):504-512. 10.3340/jkns.2019.0205.

Correlation between the Position of the Pituitary Stalk as Determined by Diffusion Tensor Imaging and Its Location as Determined at the Time of Surgical Resection of Pituitary Adenomas

• Wang Fy
• Wang P
• Yang Cx
• Zhou T
• Jiang Jl
• Meng Xh

• KMID: 2504645
• DOI: http://doi.org/10.3340/jkns.2019.0205

Abstract

Objective
: An important factor during pituitary adenoma surgery is to preserve pituitary stalk (PS) as this plays a role in reduction of the risk of postoperative diabetes insipidus. The hypothalamic-hypophyseal tract (HHT) projects through the PS to the posterior pituitary gland. To reconstruct white matter fiber pathways, methods like diffusion tensor imaging (DTI) tractography have been widely used. In this report we attempted to predict the position of PS using DTI tractography and to assess its intraoperative correlation during surgery of pituitary adenomas.
Methods
: DTI tractography was used to tract the HHT in nine patients before craniotomy for pituitary adenomas. The DTI location of the HHT was compared with the PS position identified at the time of surgery. DTI fiber tracking was carried out in nine patients prior to the planned craniotomy for pituitary adenomas. In one patient, the PS could not be identified during the surgery. In the other eight patients, a comparison was made between the location of the HHT identified by DTI and the position of the PS visualized at the time of surgery.
Results
: The position of the HHT identified by DTI showed consistency with the intraoperative position of the PS in seven patients (88.9% concordance).
Conclusion
: This study shows that DTI can identify the position of the HHT and thus the position of the PS with a high degree of reliability.

Keyword

Diffusion tensor imaging; Hypothalamohypophyseal tract

Figure

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  Fig. 1. HHT visualization in a patient with pituitary adenoma. A : The contour of the head with 2 ROIs and HHT. B : The yellow contour of the adenoma in the axial plane. C : Two yellow planes show 2 ROI masks. D : HHT after proper pruning [29]. HHT : hypothalamic-hypophyseal tract, ROI : regions of interest.

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  Fig. 2. HHT visualization in case 1. A : Red contour of the HHT and yellow contour of the adenoma. B : The green translucent part shows a 3D anatomical model of the tumor, and the red part shows the contour of the tracts. C : Intraoperative view of pituitary stalk using the operating microscope. Position of the tracts was consistent with the intraoperative view of the pituitary stalk. PS : pituitary stalk, LON : left optic nerve, ACP : anterior clinoid process, ICA : internal carotid artery, HHT : hypothalamic-hypophyseal tract.

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  Fig. 3. HHT visualization in case 2. A : Red contour of the HHT and yellow contour of the pituitary adenoma. B : The green translucent part is a 3D anatomical model of the tumor, and the red part shows the contour of tracts. C : Visualization of the pituitary stalk at the time of surgery. Position of the tracts was consistent with the intraoperative observations of the position of the pituitary stalk. ON : optic nerve, ICA : internal carotid artery, PS : pituitary stalk, HHT : hypothalamic-hypophyseal tract.

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  Fig. 4. HHT visualization in case 3. A : Red contour of the HHT and yellow contour of the adenoma. B : The green translucent part shows a 3D anatomical model of the tumor, and the red part shows the contour of the tracts. C : Intra-operative location of the pituitary stalk. Position of the tracts was consistent with intraoperative observations of the location of the pituitary stalk. TS : tuberculum sellae, PS : pituitary stalk, HHT : hypothalamichypophyseal tract.

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  Fig. 5. HHT visualization in case 4. A : The yellow translucent part shows a 3D anatomical model of the tumor, and the red part shows the contour of tracts. The tracts were encased by the tumor. B : Postoperative MRI demonstrated residual tumor. The red part shows the contour of tracts. The tracts were encased by the residual tumor. HHT : hypothalamichypophyseal tract, MRI : magnetic resonance imaging.

Reference

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