Postoperative computed tomographic evaluation of patients with large pituitary tumors treated with operative decompression and radiation therapy

Thirty consecutive patients who underwent operative decompression and radiation therapy for large sellar and suprasellar pituitary tumors (≥2 cm) were studied in terms of the serial computed tomographic (CT) changes. There were 23 men and 7 women. The mean age was 49.6 ± 2.5 years, and the mean follow-up was 45.3 ± 3.9 months. Twenty-eight of the 30 patients had transsphenoidal surgery, and 27 had hormonally inactive tumors. Radiation therapy was begun within 1 month of surgery with a mean dose of 4855 ± 70 cGy. Postoperative CT scans were obtained within 1 month of surgery and at 6- to 12-month intervals thereafter. Fourteen patients (45%) had no suprasellar tumor visualized in either the early postoperative CT scans or on subsequent scans. Eleven patients (35%) had a persistent suprasellar mass during the early postoperative period that resolved on serial CT evaluation. The mean time for resolution was 10.4 ± 1.2 months. Six patients (20%) had a persistent suprasellar mass on serial CT evaluation. A persistent postoperative mass that subsequently resolved in many of the patients was thought to be caused by the gradual retraction of the postoperative packing and hematoma, as well as the effect of radiation on any residual tumor.