Acta Neurochirurgica

, Volume 160, Issue 5, pp 1029–1039 | Cite as

Post-operative imaging assessment of non-functioning pituitary adenomas

  • Kunal S. Patel
  • Sanjay Dhawan
  • Renzhi Wang
  • Bob S. Carter
  • James Y. Chen
  • Clark C. Chen
Review Article - Pituitaries



Non-functioning pituitary adenomas (NFAs) are the most common pituitary tumors. There is significant variability in clinical practice in terms of post-operative imaging evaluation. The objective of this manuscript is to provide an exhaustive review of published articles pertaining to the post-operative imaging evaluation of NFAs.


The MEDLINE database was queried for studies investigating imaging for the post-operative evaluation of pituitary adenomas. From an initial search of 5589 articles, 37 articles were evaluated in detail and included in this review.


Magnetic resonance imaging (MRI) is the gold standard for post-operative monitoring of NFAs, although functional imaging modalities may improve identification of residual tumor in conjunction with MRI. The residual tumor can be distinguished from post-operative changes by experienced practitioners using high-resolution MRI in the immediate post-operative setting (within 1 week of surgery). However, continued imaging evolution in the appearance of residual tumor or resection cavity is expected up to 3 months post-operatively.


Post-operative imaging appearance of the pituitary gland, optic apparatus, and pneumocephalus patterns, correlated with the clinical outcomes. Long-term, lifetime follow-up is warranted for NFA patients who underwent surgical resection.


Non-functioning pituitary adenomas Post-operative Computed tomography Magnetic resonance imaging 


Compliance with ethical standards

Informed consent

This manuscript is a review article. For this type of study formal consent is not required.

Conflict of interest


Ethical approval

This manuscript is a review article. For this type of study formal consent is not required.

Animal experiments

This article does not contain any studies with animals performed by any of the authors.


  1. 1.
    Banu MA, Szentirmai O, Mascarenhas L, Salek AA, Anand VK, Schwartz TH (2014) Pneumocephalus patterns following endonasal endoscopic skull base surgery as predictors of postoperative CSF leaks. J Neurosurg 121:961–975. CrossRefPubMedGoogle Scholar
  2. 2.
    Berkmann S, Schlaffer S, Buchfelder M (2013) Tumor shrinkage after transsphenoidal surgery for nonfunctioning pituitary adenoma. J Neurosurg 119:1447–1452. CrossRefPubMedGoogle Scholar
  3. 3.
    Bladowska J, Bednarek-Tupikowska G, Sokolska V, Badowski R, Moroń K, Bonicki W, Sąsiadek M (2010) MRI image characteristics of materials implanted at sellar region after transsphenoidal resection of pituitary tumours. Pol J Radiol 75:46–54PubMedPubMedCentralGoogle Scholar
  4. 4.
    Bladowska J, Sokolska V, Sozański T, Bednarek-Tupikowska G, Sąsiadek M (2010) Comparison of post-surgical MRI presentation of the pituitary gland and its hormonal function. Pol J Radiol 75:29–36PubMedPubMedCentralGoogle Scholar
  5. 5.
    Colao A, Ferone D, Lombardi G, Lastoria S (2002) (99m)Technetium pentavalent dimercaptosuccinic acid scintigraphy in the follow-up of clinically nonfunctioning pituitary adenomas after radiotherapy. Clin Endocrinol 56:713–721CrossRefGoogle Scholar
  6. 6.
    Connor SE, Deasy NP (2002) MRI appearances of the sphenoid sinus at the late follow-up of transsphenoidal surgery for pituitary macroadenoma. Australas Radiol 46:33–40CrossRefPubMedGoogle Scholar
  7. 7.
    Coulter IC, Mukerji N, Bradey N, Connolly V, Kane PJ (2009) Radiologic follow-up of non-functioning pituitary adenomas: rationale and cost effectiveness. J Neuro-Oncol 93:157–163. CrossRefGoogle Scholar
  8. 8.
    Deconde AS, Vira D, Thompson CF, Wang MB, Bergsneider M, Suh JD (2013) Radiologic assessment of the paranasal sinuses after endoscopic skull base surgery. J Neurol Surg B Skull Base 74:351–357. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Dina TS, Feaster SH, Laws ER Jr, Davis DO (1993) MR of the pituitary gland postsurgery: serial MR studies following transsphenoidal resection. AJNR Am J Neuroradiol 14:763–769PubMedGoogle Scholar
  10. 10.
    Dolinskas CA, Simeone FA (1985) Transsphenoidal hypophysectomy: post surgical CT findings. AJR Am J Roentgenol 144:487–492. CrossRefPubMedGoogle Scholar
  11. 11.
    Greenman Y, Ouaknine G, Veshchev I, Reider-Groswasser II, Segev Y, Stern N (2003) Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth. Clin Endocrinol 58:763–769CrossRefGoogle Scholar
  12. 12.
    Hald JK, Eldevik OP, Dunn RL, Bakke SJ, Pedersen HK, Nakstad PH (2000) Improving postoperative MR imaging of pituitary macroadenomas: comparison of full and reduced dose of gadopentetate dimeglumine. Eur Radiol 10:1068–1072. CrossRefPubMedGoogle Scholar
  13. 13.
    Hald JK, Nakstad PH, Kollevold T, Bakke SJ, Skalpe IO (1992) MR imaging of pituitary macroadenomas before and after transsphenoidal surgery. Acta Radiol 33:396–399CrossRefPubMedGoogle Scholar
  14. 14.
    Kaplan HC, Baker HL, Houser OW, Laws ER, Abboud CF, Scheithauer BW (1985) CT of the sella turcica after transsphenoidal resection of pituitary adenomas. AJR Am J Roentgenol 145:1131–1140. CrossRefPubMedGoogle Scholar
  15. 15.
    Kiliç T, Ekinci G, Seker A, Elmaci I, Erzen C, Pamir MN (2001) Determining optimal MRI follow-up after transsphenoidal surgery for pituitary adenoma: scan at 24 hours post surgery provides reliable information. Acta Neurochir 143:1103–1126. CrossRefPubMedGoogle Scholar
  16. 16.
    Kopp C, Theodorou M, Poullos N, Jacob V, Astner ST, Molls M, Grosu AL (2012) Tumor shrinkage assessed by volumetric MRI in long-term follow-up after fractionated stereotactic radiotherapy of nonfunctioning pituitary adenoma. Int J Radiat Oncol Biol Phys 82:1262–1267. CrossRefPubMedGoogle Scholar
  17. 17.
    Kremer P, Forsting M, Hamer J, Sartor K (1996) MR imaging of residual tumor tissue after transsphenoidal surgery of hormone-inactive pituitary macroadenomas: a prospective study. Acta Neurochir Suppl 65:27–30PubMedGoogle Scholar
  18. 18.
    Kremer P, Forsting M, Ranaei G, Wüster C, Hamer J, Sartor K, Kunze S (2002) Magnetic resonance imaging after transsphenoidal surgery of clinically non-functional pituitary macroadenomas and its impact on detecting residual adenoma. Acta Neurochir 144:433–443. CrossRefPubMedGoogle Scholar
  19. 19.
    Mansouri A, Symons S, Schwartz M, Chen J, Pirouzmand F (2012) Quantitative volumetric analysis post transsphenoidal pituitary adenoma surgery. Can J Neurol Sci 39:600–604CrossRefPubMedGoogle Scholar
  20. 20.
    Mikhael MA, Ciric IS (1988) MR imaging of pituitary tumors before and after surgical and/or medical treatment. J Comput Assist Tomogr 12:441–445CrossRefPubMedGoogle Scholar
  21. 21.
    Miki Y, Kanagaki M, Takahashi JA, Ishizu K, Nakagawa M, Yamamoto A, Fushimi Y, Okada T, Mikuni N, Kikuta K, Hashimoto N, Togashi K (2007) Evaluation of pituitary macroadenomas with multidetector-row CT (MDCT): comparison with MR imaging. Neuroradiology 49:327–333. CrossRefPubMedGoogle Scholar
  22. 22.
    Muhr C, Bergström K, Hugosson R, Lundberg PO (1980) Pituitary adenomas: computed tomography and clinical evaluation in a follow-up after surgical treatment. Eur Neurol 19:171–179CrossRefPubMedGoogle Scholar
  23. 23.
    Nakasu Y, Itoh R, Nakasu S, Nioka H, Kidooka M, Handa J (1998) Postoperative sella: evaluation with fast spin echo T2-weighted high-resolution imaging. Neurosurgery 43:440–446 discussion 446-447CrossRefPubMedGoogle Scholar
  24. 24.
    Nelson PB, Robinson AG, Hirsch W (1991) Postoperative computed tomographic evaluation of patients with large pituitary tumors treated with operative decompression and radiation therapy. Neurosurgery 28:238–240 discussion 240-231CrossRefPubMedGoogle Scholar
  25. 25.
    Patel KS, Kazam J, Tsiouris AJ, Anand VK, Schwartz TH (2014) Utility of early postoperative high-resolution volumetric magnetic resonance imaging after transsphenoidal pituitary tumor surgery. World Neurosurg.
  26. 26.
    Rajaraman V, Schulder M (1999) Postoperative MRI appearance after transsphenoidal pituitary tumor resection. Surg Neurol. United States, pp 592–598. discussion 598–599Google Scholar
  27. 27.
    Reddy R, Cudlip S, Byrne JV, Karavitaki N, Wass JA (2011) Can we ever stop imaging in surgically treated and radiotherapy-naive patients with non-functioning pituitary adenoma? Eur J Endocrinol 165:739–744. CrossRefPubMedGoogle Scholar
  28. 28.
    Rodriguez O, Mateos B, de la Pedraja R, Villoria R, Hernando JI, Pastor A, Pomposo I, Aurrecoechea J (1996) Postoperative follow-up of pituitary adenomas after transsphenoidal resection: MRI and clinical correlation. Neuroradiology 38:747–754CrossRefPubMedGoogle Scholar
  29. 29.
    Saeki N, Hoshi S, Sunada S, Sunami K, Murai H, Kubota M, Tatsuno I, Iuchi T, Yamaura A (2002) Correlation of high signal intensity of the pituitary stalk in macroadenoma and postoperative diabetes insipidus. AJNR Am J Neuroradiol 23:822–827PubMedGoogle Scholar
  30. 30.
    Soto-Ares G, Cortet-Rudelli C, Assaker R, Boulinguez A, Dubest C, Dewailly D, Pruvo JP (2002) MRI protocol technique in the optimal therapeutic strategy of non-functioning pituitary adenomas. Eur J Endocrinol 146:179–186CrossRefPubMedGoogle Scholar
  31. 31.
    Steiner E, Knosp E, Herold CJ, Kramer J, Stiglbauer R, Staniszewski K, Imhof H (1992) Pituitary adenomas: findings of postoperative MR imaging. Radiology 185:521–527CrossRefPubMedGoogle Scholar
  32. 32.
    Stickney KO, Weymuller EA, Mayberg M (1994) MRI evaluation of the sphenoid sinus after transsphenoidal approach to the pituitary. Laryngoscope 104:1–4. PubMedGoogle Scholar
  33. 33.
    Stofko DL, Nickles T, Sun H, Dehdashti AR (2014) The value of immediate postoperative MR imaging following endoscopic endonasal pituitary surgery. Acta Neurochir 156:133–140; discussion 140. CrossRefPubMedGoogle Scholar
  34. 34.
    Taberner López E, Vañó Molina M, Calatayud Gregori J et al (2017) Assessment of the extent of pituitary macroadenomas resection in immediate postoperative MRI. Radiologia (17):30181–30189.
  35. 35.
    Tung GA, Noren GRogg JM, Jackson IM (2001) MR imaging of pituitary adenomas after gamma knife stereotactic radiosurgery. AJR Am J Roentgenol 177:919–924. CrossRefPubMedGoogle Scholar
  36. 36.
    Wu LM, Li YL, Yin YH, Hou GQ, Zhu R, Hua XL, Xu JR, Chen ZA (2014) Usefulness of dual-energy computed tomography imaging in the differential diagnosis of sellar meningiomas and pituitary adenomas: preliminary report. PLoS One 9:e90658. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Yoneoka Y, Hatase T, Watanabe N, Jinguji S, Okada M, Takagi M, Fujii Y (2014) Early morphological recovery of the optic chiasm is associated with excellent visual outcome in patients with compressive chiasmal syndrome caused by pituitary tumors. Neurol Res 1743132814Y0000000407.
  38. 38.
    Zhao X, Xiao J, Xing B, Wang R, Zhu Z, Li F (2014) Comparison of (68)Ga DOTATATE to 18F-FDG uptake is useful in the differentiation of residual or recurrent pituitary adenoma from the remaining pituitary tissue after transsphenoidal adenomectomy. Clin Nucl Med 39:605–608. CrossRefPubMedGoogle Scholar
  39. 39.
    Ziu M, Dunn I, Hess C et al (2016) Congress of neurological surgeons systematic review and evidence-based guideline on posttreatment follow-up evaluation of patients with nonfunctioning pituitary adenomas. Neurosurgery 79(4):E541–E543CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Kunal S. Patel
    • 1
  • Sanjay Dhawan
    • 2
  • Renzhi Wang
    • 3
  • Bob S. Carter
    • 4
  • James Y. Chen
    • 5
    • 6
  • Clark C. Chen
    • 2
  1. 1.Department of NeurosurgeryUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Department of NeurosurgeryUniversity of MinnesotaMinneapolisUSA
  3. 3.Department of NeurosurgeryPeking Union Medical College HospitalBeijingChina
  4. 4.Department of Neurosurgery, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  5. 5.Department of Radiology, UC San Diego Health SystemUniversity of California, San DiegoLa JollaUSA
  6. 6.Department of RadiologySan Diego Veterans Administration Health SystemSan DiegoUSA

Personalised recommendations