Pituitary adenomas with subarachnoid invasion: clinical characteristics, radiographic features, surgical management, and outcomes.
Subarachnoid invasion is associated with much lower gross-total resection rates in pituitary adenomas.
Pituitary adenomas with subarachnoid invasion: clinical characteristics, radiographic features, surgical management, and outcomes.
The goal of this study was to elucidate the clinical and radiographic features of subarachnoid adenomas and to characterize the outcomes after resection of these challenging tumors.
Data were collected from 436 consecutive pituitary adenomas that underwent endoscopic endonasal approaches (endoscopic endonasal approaches), combined endoscopic endonasal approaches/open transcranial approaches, and open transcranial approaches for tumor resection from 2018 to 2024.
subarachnoid invasion nearly halves the chance of completely removing the tumor
Subarachnoid invasion was identified in 8% of pituitary adenomas that underwent resection.
Endoscopic endonasal approaches was the primary surgical approach utilized for resection (80%), although combined endoscopic endonasal approaches/open transcranial (14%) and open transcranial approaches (6%) were also utilized for subarachnoid adenomas.
Tumors with subarachnoid invasion were also associated with increased postoperative hematomas (p = 0.05), perforator infarcts (p < 0.01), and postoperative hydrocephalus requiring shunt placement (p < 0.001).
NETS scores ≥ 3 demonstrated 91% sensitivity and 99% negative predictive value for subarachnoid invasion.
Subarachnoid adenomas are associated with high morbidity due to their close association with critical neurovascular structures.
Invasive tumor biology and prior arachnoid disruption likely contribute to the nodular invasion and subarachnoid vessel encasement that are characteristic of these challenging tumors.
The NETS score is a highly sensitive predictive score that can assist in preoperative identification and facilitate appropriate surgical planning.