Change in the pituitary stalk deviation angle after transsphenoidal surgery can predict the development of diabetes insipidus for pituitary adenomas

Abstract

Purpose: We aimed to assess the factors influencing the development of diabetes insipidus after transsphenoidal surgery for pituitary adenomas.

Methods: A retrospective analysis was conducted on the clinical data of patients with pituitary adenomas who underwent transsphenoidal surgery. The predictors of postoperative diabetes insipidus were determined using statistical analysis.

Results: Of the 415 patients who underwent microscopic transsphenoidal surgery for pituitary adenomas, 196 experienced postoperative diabetes insipidus. The sinking depth of the diaphragma sellae and the difference between the preoperative and postoperative pituitary stalk deviation angles in the diabetes insipidus group were greater than those in the non-diabetes insipidus group. Logistic regression analysis showed that the risk of diabetes insipidus after transsphenoidal surgery was higher in patients with a larger difference in their pituitary stalk deviation angles (odds ratio = 2.407, 95% CI = 1.335-4.342; P = 0.004).

Conclusion: The difference in the pituitary stalk deviation angle could predict the onset of diabetes insipidus after transsphenoidal surgery for pituitary adenomas.

Keywords: diabetes insipidus; diaphragma sellae; pituitary adenomas; pituitary stalk; transsphenoidal surgery.

Figure 1

The imaginary angle between two edges of the diaphragma sellae: the beginning of its elevation and its highest point.

Figure 2

Coronal contrast-enhanced images of the pituitary stalk deviation angle before transsphenoidal surgery. The pituitary stalk is deviated 47.28° to the left.

Figure 3

Magnetic resonance imaging reveals changes in the diaphragma sellae before and after transsphenoidal surgery in two cases. (A) and (B) correspond to one of the cases, and (C) and (D) to the other. Diaphragma sellae (arrow). (A) Hypointense shadow of the diaphragma sellae in preoperative T2-weighted imaging; diaphragma sellae height: 8.7 mm. (B) The sinking depth of the diaphragma sellae is the difference between the two values (8.7–3.4 mm). (C) Hypointense shadow of the diaphragma sellae in preoperative T2-weighted imaging; diaphragma sellae height: 12.38 mm. (D) The sinking depth of the diaphragma sellae is the difference between the two values (12.38–0 mm).

Figure 4

The validation of the logistic regression model showed that area under the receiver operating characteristic curves was 0.732.