{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T01:24:56Z","timestamp":1789781096854,"version":"4.0.1"},"reference-count":76,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The present study aimed to investigate the association between pituitary adenoma (PA) consistency and other measurable tumor characteristics, extent of resection (EOR), postoperative complications, and outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>In total, 507 PA resections were intraoperatively assigned a consistency grade from 1 (cystic\/hemorrhagic tumors) to 5 (calcified tumors) based on intraoperative tumor characteristics. Tumor consistency was analyzed in tertiles (grades 1 and 2, grade 3, and grades 4 and 5) to determine associations with tumor characteristics, EOR, recurrence, postoperative outcomes, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The cohort in this study included primarily macroadenomas (93.3%) comprised mostly of nonfunctional PAs (NFPAs) (79.5%), with 77.1% showing suprasellar extension, 16.6% showing infrasellar invasion, and 46.4% showing cavernous sinus invasion (CSI). PA consistency grades were as follows: grade 1 or 2 (40.6%), grade 3 (39.3%), and grade 4 or 5 (20.1%). Compared with grade 1 or 2, higher-consistency PAs were more common in men (p = 0.001) and trended toward lower rates of gross-total resection (GTR) (67.6% vs 53.5%, p = 0.06). Higher PA consistency was predictive of any postoperative complication (OR 1.23, 95% CI 1.05\u20131.43; p = 0.009), specifically including transient diabetes insipidus (DI) (OR 1.45, 95% CI 1.12\u20131.85; p = 0.004) and cranial nerve (CN) paresis (OR 3.45, 95% CI 1.56\u20137.69; p = 0.002). Higher consistency was a strong predictor of CN palsy (OR 3.33, 95% CI 1.52\u20137.30; p = 0.004) for NFPAs. Higher-consistency PAs were more frequently adrenocorticotropic hormone\u2013positive in both univariable (OR 1.33, 95% CI 1.11\u20131.60; p = 0.002) and multivariable (OR 1.38, 95% CI 1.11\u20131.69; p = 0.004) analyses. Higher consistency was associated with lower rates of GTR on stratification by CSI for Knosp grade 3 (p &lt; 0.001) and grade 4 (p &lt; 0.001) PAs, but not in low-grade (Knosp grades 1 and 2) PAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Tumor consistency is an important consideration for the resection strategy, particularly for PAs with CSI, and a predictor of intraoperative CSF leaks and perioperative complications and outcomes, including EOR, CN paresis, and transient DI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.8.jns232715","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T20:27:43Z","timestamp":1737750463000},"page":"1674-1681","source":"Crossref","is-referenced-by-count":12,"title":["Association between pituitary adenoma consistency, resection techniques, and patient outcomes: a single-institution experience"],"prefix":"10.3171","volume":"142","author":[{"given":"Gage A.","family":"Guerra","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zain","family":"Kashif","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Cote","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey J.","family":"Feng","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Western Michigan University Horner Stryker M.D. School of Medicine, Kalamazoo, Michigan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Renn","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Yang","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Cheok","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"},{"name":"Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Racheal","family":"Peterson","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark S.","family":"Shiroishi","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Carmichael","sequence":"additional","affiliation":[{"name":"Endocrinology, Keck School of Medicine of University of Southern California, Los Angeles, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Zada","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Endocr Rev","first-page":"1003","article-title":"Clinical biology of the pituitary adenoma","volume":"43","author":"Melmed S","year":"2022","unstructured":"Melmed S, Kaiser UB, Lopes MB,  Clinical biology of the pituitary adenoma. 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