Venous Sampling Petrosal Sinus There is no relevant literature regarding the use of venous sampling in the evaluation of pituitary apoplexy. Radiography Sella There is no relevant literature regarding the use of radiography in the evaluation of pituitary apoplexy. Variant 5: Adult. Surveillance postpituitary or sellar mass resection. Delayed surveillance is performed in patients with known subtotal pituitary adenoma resection [86], nonfunctioning pituitary adenomas [87], and postresection of sellar/suprasellar nonadenoma masses guided by tumor pathology and patient symptoms. In the immediate postoperative setting, local complications may be difficult to discern from normal postoperative changes [88,89]. There is variable literature regarding the frequency and duration of routine follow-up for nonfunctioning tumors [90,91]; however, postoperative imaging is often performed >3 months following trans-sphenoidal surgery [88]. CT Sella Assessment for tumor growth or suprasellar extension can be performed using CT, although MRI is generally considered superior. Invasion of the skull base by pituitary tumor is an uncommon but important complication that is best characterized preoperatively with CT [95]. CT with IV contrast is not typically needed in the postoperative setting, unless specifically focused on adjacent structures such as the cavernous sinuses. Dual-phase imaging with and without IV contrast is not indicated as an initial imaging study. CTA Head Routine vascular imaging following pituitary surgery is generally not indicated unless there is known or clinical suspicion for a vascular complication. MRA Head Routine vascular imaging following pituitary surgery is generally not indicated unless there is known or clinical suspicion for a vascular complication. MRI Sella MRI using high-resolution pituitary protocols is the most useful tool for diagnostic assessment following pituitary surgery.
Neuroendocrine Imaging. Venous Sampling Petrosal Sinus There is no relevant literature regarding the use of venous sampling in the evaluation of pituitary apoplexy. Radiography Sella There is no relevant literature regarding the use of radiography in the evaluation of pituitary apoplexy. Variant 5: Adult. Surveillance postpituitary or sellar mass resection. Delayed surveillance is performed in patients with known subtotal pituitary adenoma resection [86], nonfunctioning pituitary adenomas [87], and postresection of sellar/suprasellar nonadenoma masses guided by tumor pathology and patient symptoms. In the immediate postoperative setting, local complications may be difficult to discern from normal postoperative changes [88,89]. There is variable literature regarding the frequency and duration of routine follow-up for nonfunctioning tumors [90,91]; however, postoperative imaging is often performed >3 months following trans-sphenoidal surgery [88]. CT Sella Assessment for tumor growth or suprasellar extension can be performed using CT, although MRI is generally considered superior. Invasion of the skull base by pituitary tumor is an uncommon but important complication that is best characterized preoperatively with CT [95]. CT with IV contrast is not typically needed in the postoperative setting, unless specifically focused on adjacent structures such as the cavernous sinuses. Dual-phase imaging with and without IV contrast is not indicated as an initial imaging study. CTA Head Routine vascular imaging following pituitary surgery is generally not indicated unless there is known or clinical suspicion for a vascular complication. MRA Head Routine vascular imaging following pituitary surgery is generally not indicated unless there is known or clinical suspicion for a vascular complication. MRI Sella MRI using high-resolution pituitary protocols is the most useful tool for diagnostic assessment following pituitary surgery.