Bony Regeneration of the Sella after Transsphenoidal Pituitary Surgery

Objective

The purpose of this study is to demonstrate the possible bony regrowth of the sella after transsphenoidal surgery without any intraoperative sellar reconstruction.

Methods

Radiologic findings of the sella were reviewed in patients with pituitary tumors treated by transsphenoidal surgery. In 17 patients who had postoperative cranial computed tomography scans, bony regeneration of the sellar floor was evaluated by comparing immediate and late postoperative scans. The bony opening reduction was measured in transverse and sagittal planes.

Results

The median bony opening diameter in the transverse plane was 8.8 mm (interquartile range [IQR] 5.7–11.4) on the first scan and 4.2 mm (IQR 0.8–6.8) on the second scan. In the sagittal plane, it was 4.8 mm (IQR 1.8–6.8) on the first scan and 2.9 mm (IQR 1.6–3.9) on the second scan. These changes occurred in a median time of 36 months (IQR 22–42). There was a statistically significant decrease of the bony opening diameters in both the transverse and sagittal planes (P < 0.0001 and P = 0.0004, respectively). Bone regeneration was observed in 16 of the 17 patients (approximately 94%).

Conclusion

There is a natural bony regeneration of the sella after transsphenoidal pituitary surgery.

Introduction

Since its introduction, minimally invasive endoscopic transsphenoidal surgery has evolved considerably and has become the procedure of choice for the treatment of pituitary tumors.1, 2 It provides favorable outcomes with less tissue dissection and a relatively low complication rate.³ Due to the minimally invasive nature of this procedure, the reconstruction of the sella after tumor resection is not necessary in most cases and is mostly limited to the intraoperative management of cerebrospinal fluid leaks.4, 5, 6 The natural evolution of a sellar defect without any reconstruction has been poorly investigated. We found that in many patients who were subjected to a second surgery, a sellar exposure was necessary to access the tumors. In addition, we have encountered cases where widening of the pre-exiting bony opening was also necessary. On the basis of these findings, we hypothesized that the sella could regenerate without any reconstruction. The purpose of this study is to determine whether a bony regrowth of the sella, after transsphenoidal surgery without any reconstruction, takes place.