{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T11:24:17Z","timestamp":1786965857765,"version":"build-2736575974"},"reference-count":89,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,15]],"date-time":"2026-08-15T00:00:00Z","timestamp":1786752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Acromegaly is almost always caused by a growth hormone-secreting pituitary adenoma, and long-term cure depends on complete surgical resection and accurate detection of residual or recurrent disease on surveillance imaging. This pictorial review focuses on the 3\u20136-month postoperative interval, when routine surveillance MRI is commonly performed and dynamic contrast-enhanced pituitary imaging can be correlated with IGF-1 and GH trends. We first reviewnormal pituitary anatomy and imaging characteristics, and the typical location and signal characteristics of somatotroph adenomas, as a baseline for postoperative interpretation. Using representative cases of surgically treated acromegaly, we then illustrate the key postoperative MRI appearances on high-resolution T1- and T2-weighted and dynamic contrast-enhanced sequences. Benign patterns include non-enhancing T1-hyperintense packing material, thin rim or septal enhancement around thesurgical cavity, sheet-like floor-based granulation tissue, and simple stalk deviation with nromal rangecaliber, often seen in biochemically cured patients. High-risk imaging patterns comprise nodular or thick enhancing tissue in the resection bed, new or progressive cavernous sinus soft tissue, stalk thickening with avid enhancement, and a spectrum of cavernous carotid abnormalities. For each pattern, we emphasize prevalence, typical signal and enhancement characteristics, and reported correlations with biochemical remission or persistence of disease. Finally, we propose a simple flowchart that integrates biochemical status with these reproducible imaging findings to stratify patients into expected postoperative change, probable residual\/recurrent adenoma, vascular complication, or indeterminate category. This pattern-based biochemical\u2013radiologic framework is intended to help radiologists and endocrinologists interpret mid-term postoperative pituitary MRI in acromegaly more confidently and consistently.<\/jats:p>","DOI":"10.3390\/diagnostics16162582","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T10:04:36Z","timestamp":1786961076000},"page":"2582","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Pituitary MRI Findings in Acromegaly: A Pictorial Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5601-6392","authenticated-orcid":false,"given":"Mahyar","family":"Daskareh","sequence":"first","affiliation":[{"name":"Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA"},{"name":"Radiology Department, Ziaeian Hospital, Tehran 1366736511, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3321-5061","authenticated-orcid":false,"given":"Fatemeh","family":"Abbasi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Islamic Azad University, Tonekabon 4684161167, Iran"},{"name":"Clinical Research Development Unit of Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1964714953, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6170-0177","authenticated-orcid":false,"given":"Negar","family":"Emamzadeh","sequence":"additional","affiliation":[{"name":"School of Medicine, Iran University of Medical Sciences, Tehran 14149614535, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7857-7315","authenticated-orcid":false,"given":"Vahid","family":"Shahmaei","sequence":"additional","affiliation":[{"name":"Radiology Technology Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1971653313, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1097-4509","authenticated-orcid":false,"given":"Mohammad","family":"Ghorbani","sequence":"additional","affiliation":[{"name":"Orthopedic Research Center, Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad 9137913131, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/S2213-8587(22)00244-3","article-title":"Acromegaly: Pathogenesis, diagnosis, and management","volume":"10","author":"Fleseriu","year":"2022","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1530\/EJE-21-0216","article-title":"Global epidemiology of acromegaly: A systematic review and meta-analysis","volume":"185","author":"Crisafulli","year":"2021","journal-title":"Eur. J. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e13302","DOI":"10.1111\/bpa.13302","article-title":"The 2022 WHO classification of tumors of the pituitary gland: An update on aggressive and metastatic pituitary neuroendocrine tumors","volume":"35","author":"Burman","year":"2025","journal-title":"Brain Pathol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"9919","DOI":"10.1038\/s41598-022-12980-1","article-title":"Prospective intraoperative and histologic evaluation of cavernous sinus medial wall invasion by pituitary adenomas and its implications for acromegaly remission outcomes","volume":"12","author":"Mohyeldin","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3003","DOI":"10.1007\/s00701-023-05772-7","article-title":"Long-term control of acromegaly after pituitary surgery in South-Eastern Norway","volume":"165","author":"Falch","year":"2023","journal-title":"Acta Neurochir."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"618","DOI":"10.3171\/2021.11.JNS212137","article-title":"Determinants of immediate and long-term remission after initial transsphenoidal surgery for acromegaly and outcome patterns during follow-up: A longitudinal study on 659 patients","volume":"137","author":"Guo","year":"2022","journal-title":"J. Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1007\/s40618-024-02321-6","article-title":"Recurrence in acromegaly: Two tertiary centers experience and review of the literature","volume":"47","author":"Cremaschi","year":"2024","journal-title":"J. Endocrinol. Investig."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s11102-023-01360-1","article-title":"Consensus on criteria for acromegaly diagnosis and remission","volume":"27","author":"Giustina","year":"2024","journal-title":"Pituitary"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1038\/s41574-018-0058-5","article-title":"A Consensus Statement on acromegaly therapeutic outcomes","volume":"14","author":"Melmed","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1038\/s41574-025-01148-2","article-title":"Consensus on acromegaly therapeutic outcomes: An update","volume":"21","author":"Melmed","year":"2025","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e16089","DOI":"10.1097\/MD.0000000000016089","article-title":"Differentiation of postoperative changes and residual tumors in dynamic contrast-enhanced sella MRI after transsphenoidal resection of pituitary adenoma","volume":"98","author":"Kim","year":"2019","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3933","DOI":"10.1210\/jc.2014-2700","article-title":"Acromegaly: An endocrine society clinical practice guideline","volume":"99","author":"Katznelson","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_13","unstructured":"Evanson, J. (2023). Radiology of the Pituitary. Endotext [Internet], MDText.com, Inc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"86","DOI":"10.53350\/pjmhs2216186","article-title":"Posterior Pituitary Bright Spot Normal Dimensions on MRI","volume":"16","author":"Iqbal","year":"2022","journal-title":"Pak. J. Med. Heal. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S216","DOI":"10.4103\/2230-8210.84871","article-title":"Imaging of the pituitary: Recent advances","volume":"15","author":"Chaudhary","year":"2011","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.3174\/ajnr.A4324","article-title":"High-resolution DCE-MRI of the pituitary gland using radial k-space acquisition with compressed sensing reconstruction","volume":"36","author":"Espagnet","year":"2015","journal-title":"Am. J. Neuroradiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"380","DOI":"10.4103\/ijri.IJRI_104_18","article-title":"Precontrast T1 signal measurements of normal pituitary and microadenoma: A retrospective analysis through DCE MRI signal time curves","volume":"28","author":"Kumar","year":"2018","journal-title":"Indian J. Radiol. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"904","DOI":"10.3174\/ajnr.A4220","article-title":"Pituitary-targeted dynamic contrast-enhanced multisection CT for detecting MR imaging\u2013occult functional pituitary microadenoma","volume":"36","author":"Kinoshita","year":"2015","journal-title":"Am. J. Neuroradiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1148\/radiology.178.2.1987606","article-title":"Normal and abnormal pituitary glands: Gadopentetate dimeglumine-enhanced MR imaging","volume":"178","author":"Sakamoto","year":"1991","journal-title":"Radiology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0720-048X(01)00354-0","article-title":"Dynamic gadolinium-enhanced MR imaging of pituitary adenomas: Usefulness of sequential sagittal and coronal plane images","volume":"39","author":"Gao","year":"2001","journal-title":"Eur. J. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Akirov, A., Asa, S.L., Amer, L., Shimon, I., and Ezzat, S. (2019). The clinicopathological spectrum of acromegaly. J. Clin. Med., 8.","DOI":"10.3390\/jcm8111962"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"6173","DOI":"10.1038\/s41598-018-24260-y","article-title":"Association between radiological parameters and clinical and molecular characteristics in human somatotropinomas","volume":"8","author":"Gahete","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_23","unstructured":"Larkin, S., and Ansorge, O. (2017). Pathology and pathogenesis of pituitary adenomas and other sellar lesions. Endotext [Internet], MDText.com, Inc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1210\/endrev\/bnac010","article-title":"Clinical biology of the pituitary adenoma","volume":"43","author":"Melmed","year":"2022","journal-title":"Endocr. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Nos\u00e9, V. (2013). Pathology and pathogenesis of growth hormone-secreting pituitary adenomas. Acromegaly: Diagnosis and Treatment, Future Medicine Ltd.","DOI":"10.2217\/ebo.12.139"},{"key":"ref_26","first-page":"95","article-title":"New Protocol for the MR Imaging of Pituitary Adenomas. Multiphase, Dynamic and Volumetric Imaging on MAGNETOM Skyra The Importance of StarVIBE and CAIPIRINHA Sequences","volume":"66","author":"Gardeur","year":"2016","journal-title":"Magnetom Flash"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s12020-015-0766-8","article-title":"Quantitative analyses of T2-weighted MRI as a potential marker for response to somatostatin analogs in newly diagnosed acromegaly","volume":"52","author":"Heck","year":"2016","journal-title":"Endocrine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/j.1365-2265.2011.04286.x","article-title":"Intensity of pituitary adenoma on T2-weighted magnetic resonance imaging predicts the response to octreotide treatment in newly diagnosed acromegaly","volume":"77","author":"Heck","year":"2012","journal-title":"Clin. Endocrinol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4973","DOI":"10.1210\/jc.2010-0573","article-title":"Magnetic resonance imaging as a predictor of response to somatostatin analogs in acromegaly after surgical failure","volume":"95","author":"Resmini","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","first-page":"46","article-title":"MRI image characteristics of materials implanted at sellar region after transsphenoidal resection of pituitary tumours","volume":"75","author":"Bladowska","year":"2010","journal-title":"Pol. J. Radiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1148\/radiology.185.2.1410366","article-title":"Pituitary adenomas: Findings of postoperative MR imaging","volume":"185","author":"Steiner","year":"1992","journal-title":"Radiology"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"649","DOI":"10.32598\/bcn.2023.5005.1","article-title":"The Optimal Time for Postoperative Magnetic Resonance Imaging of the Sella in Patients With Pituitary Adenoma","volume":"15","author":"Ghorbani","year":"2024","journal-title":"Basic Clin. Neurosci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1007\/s11102-022-01210-6","article-title":"Radiological evolution of autograft fat used for skull base reconstruction after transsphenoidal surgery for pituitary adenomas","volume":"25","author":"Cossu","year":"2022","journal-title":"Pituitary"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1007\/s007010100002","article-title":"Determining optimal MRI follow-up after transsphenoidal surgery for pituitary adenoma: Scan at 24 hours postsurgery provides reliable information","volume":"143","author":"Ekinci","year":"2001","journal-title":"Acta Neurochir."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"69","DOI":"10.18787\/jr.2021.00401","article-title":"Reconstruction Strategy After Endoscopic Skull-Base Surgery","volume":"29","author":"Hong","year":"2022","journal-title":"J. Rhinol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"7998","DOI":"10.1038\/s41598-022-12059-x","article-title":"Fibrin-coated collagen fleece versus absorbable dural sealant for sellar closure after transsphenoidal pituitary surgery: A comparative study","volume":"12","author":"Spitaels","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1007\/s11604-023-01400-7","article-title":"Imaging of pituitary tumors: An update with the 5th WHO Classifications\u2014Part 1. Pituitary neuroendocrine tumor (PitNET)\/pituitary adenoma","volume":"41","author":"Tsukamoto","year":"2023","journal-title":"Jpn. J. Radiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"E541","DOI":"10.1227\/NEU.0000000000001392","article-title":"Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Posttreatment Follow-up Evaluation of Patients With Nonfunctioning Pituitary Adenomas","volume":"79","author":"Ziu","year":"2016","journal-title":"Neurosurgery"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.crad.2017.12.007","article-title":"Diagnostic value of early postoperative MRI and diffusion-weighted imaging following trans-sphenoidal resection of non-functioning pituitary macroadenomas","volume":"73","author":"Hassan","year":"2018","journal-title":"Clin. Radiol."},{"key":"ref_40","first-page":"1097","article-title":"Pituitary adenomas: Early postoperative MR imaging after transsphenoidal resection","volume":"22","author":"Yoon","year":"2001","journal-title":"Am. J. Neuroradiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"761","DOI":"10.3171\/2019.11.JNS191845","article-title":"Early postoperative MRI and detection of residual adenoma after transsphenoidal pituitary surgery","volume":"134","author":"Alhilali","year":"2020","journal-title":"J. Neurosurg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"686","DOI":"10.3174\/ajnr.A3765","article-title":"Imaging features of a gelatin-thrombin matrix hemostatic agent in the intracranial surgical bed: A unique space-occupying pseudomass","volume":"35","author":"Learned","year":"2014","journal-title":"Am. J. Neuroradiol."},{"key":"ref_43","first-page":"29","article-title":"Comparison of post-surgical MRI presentation of the pituitary gland and its hormonal function","volume":"75","author":"Bladowska","year":"2010","journal-title":"Pol. J. Radiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e70574","DOI":"10.1111\/cns.70574","article-title":"Factors Influencing Hormone Remission in Growth Hormone-Secreting Pituitary Neuroendocrine Tumors With Residual Tumor: A Retrospective Cohort Study","volume":"31","author":"Wang","year":"2025","journal-title":"CNS Neurosci. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"4320","DOI":"10.1210\/jc.2003-032141","article-title":"Pituitary magnetic resonance imaging is not required in the postoperative follow-up of acromegalic patients with long-term biochemical cure after transsphenoidal surgery","volume":"89","author":"Zirkzee","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1530\/EJE-16-0639","article-title":"Successful treatment of residual pituitary adenoma in persistent acromegaly following localisation by 11C-methionine PET co-registered with MRI","volume":"175","author":"Koulouri","year":"2016","journal-title":"Eur. J. Endocrinol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1148\/radiol.2020200723","article-title":"Thin-slice pituitary MRI with deep learning\u2013based reconstruction: Diagnostic performance in a postoperative setting","volume":"298","author":"Kim","year":"2021","journal-title":"Radiology"},{"key":"ref_48","first-page":"763","article-title":"MR of the pituitary gland postsurgery: Serial MR studies following transsphenoidal resection","volume":"14","author":"Dina","year":"1993","journal-title":"Am. J. Neuroradiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1007\/s002340050341","article-title":"Postoperative follow-up of pituitary adenomas after trans-sphenoidal resection: MRI and clinical correlation","volume":"38","author":"Rodriguez","year":"1996","journal-title":"Neuroradiology"},{"key":"ref_50","first-page":"Doc07","article-title":"Sellar reconstruction without intrasellar packing after endoscopic surgery of pituitary macroadenomas is better than its reputation","volume":"14","author":"Ismail","year":"2016","journal-title":"Ger. Med. Sci."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Lu, L., Wan, X., Xu, Y., Chen, J., Shu, K., and Lei, T. (2022). Classifying pituitary adenoma invasiveness based on radiological, surgical and histological features: A retrospective assessment of 903 cases. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092464"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1055\/s-0043-57233","article-title":"Predictors of Remission of Acromegaly following Surgical Treatment in Growth Hormone-Secreting Pituitary Adenoma","volume":"85","author":"Konar","year":"2024","journal-title":"J. Neurol. Surg. Part B Skull Base"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1080\/01616412.2017.1296653","article-title":"Efficacy of transsphenoidal surgery in achieving biochemical cure of growth hormone-secreting pituitary adenomas among patients with cavernous sinus invasion: A systematic review and meta-analysis","volume":"39","author":"Briceno","year":"2017","journal-title":"Neurol. Res."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Bray, D.P., Mannam, S., Rindler, R.S., Quillin, J.W., and Oyesiku, N.M. (2022). Surgery for acromegaly: Indications and goals. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.924589"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1111\/j.1552-6569.2012.00710.x","article-title":"Evaluation of MRI criteria for cavernous sinus invasion in pituitary macroadenoma","volume":"24","author":"Sol","year":"2014","journal-title":"J. Neuroimaging"},{"key":"ref_56","first-page":"050","article-title":"Cavernous sinus invasion imaging versus clinical outcomes of pituitary adenomas","volume":"5","author":"Pecorari","year":"2023","journal-title":"Arch. Surg. Surg. Educ."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1159\/000506641","article-title":"Pituitary stalk enlargement in adults","volume":"110","author":"Salenave","year":"2020","journal-title":"Neuroendocrinology"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Zhang, H., Zhang, S., Shang, M., Wang, J., Wei, L., and Wang, S. (2023). Pituitary stalk changes on magnetic resonance imaging following pituitary adenoma resection using a transsphenoidal approach. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1049577"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Becker, R., Hlavac, M., Etzrodt-Walter, G., Sommer, F., Wirtz, C.R., Schmitz, B., and Pala, A. (2023). Pituitary Stalk Morphology as a Predictor of New-Onset Adrenocortical Insufficiency and Arginine Vasopressin Deficiency after Transsphenoidal Resections of Pituitary Macroadenomas: A Retrospective Single-Center Study with a Focus on iMRI. Cancers, 15.","DOI":"10.3390\/cancers15153929"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Kluczy\u0144ski, \u0141., Gilis-Januszewska, A., Godlewska, M., W\u00f3jcik, M., Zygmunt-G\u00f3rska, A., Starzyk, J., and Hubalewska-Dydejczyk, A. (2021). Diversity of pathological conditions affecting pituitary stalk. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081692"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"534","DOI":"10.4158\/EP-2018-0550","article-title":"Pituitary stalk thickening in a large cohort: Toward more accurate predictors of pituitary dysfunction and etiology","volume":"25","author":"Ling","year":"2019","journal-title":"Endocr. Pract."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"e637","DOI":"10.1016\/j.wneu.2021.08.117","article-title":"The difference between preoperative and postoperative pituitary stalk deviation angles can predict delayed hyponatremia after transsphenoidal surgery","volume":"155","author":"Lin","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e220187","DOI":"10.1530\/EC-22-0187","article-title":"Change in the pituitary stalk deviation angle after transsphenoidal surgery can predict the development of diabetes insipidus for pituitary adenomas","volume":"11","author":"Xue","year":"2022","journal-title":"Endocr. Connect."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1530\/EJE-20-0058","article-title":"Central diabetes insipidus and pituitary stalk thickening in adults: Distinction of neoplastic from non-neoplastic lesions","volume":"183","author":"Devuyst","year":"2020","journal-title":"Eur. J. Endocrinol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"40792","DOI":"10.1038\/srep40792","article-title":"Different volumetric measurement methods for pituitary adenomas and their crucial clinical significance","volume":"7","author":"Chuang","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_66","first-page":"744","article-title":"Recommendations for the diagnosis and radiological follow-up of pituitary neuroendocrine tumours","volume":"69","author":"Villar","year":"2022","journal-title":"Endocrinol. Diabetes Y Nutr. (Engl. Ed.)"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1007\/s00234-003-1018-9","article-title":"MRI of ectopic posterior pituitary bright spot with large adenomas: Appearances and relationship to transient postoperative diabetes insipidus","volume":"45","author":"Saeki","year":"2003","journal-title":"Neuroradiology"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s11102-018-0885-3","article-title":"Presence of the posterior pituitary bright spot sign on MRI in the general population: A comparison between 1.5 and 3T MRI and between 2D-T1 spin-echo-and 3D-T1 gradient-echo sequences","volume":"21","author":"Klyn","year":"2018","journal-title":"Pituitary"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1007\/s003300050261","article-title":"Magnetic resonance imaging of posterior pituitary for evaluation of the neurohypophyseal function in idiopathic and autosomal dominant neurohypophyseal diabetes insipidus","volume":"7","author":"Ozata","year":"1997","journal-title":"Eur. Radiol."},{"key":"ref_70","first-page":"6579","article-title":"The relationship between posterior pituitary bright spot on magnetic resonance imaging (MRI) and postoperative diabetes insipidus for pituitary adenoma patients","volume":"24","author":"Wang","year":"2018","journal-title":"Med. Sci. Monit. Int. Med. J. Exp. Clin. Res."},{"key":"ref_71","first-page":"943","article-title":"Frequency and variation of the posterior pituitary bright signal on MR images","volume":"10","author":"Brooks","year":"1989","journal-title":"Am. J. Neuroradiol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1148\/radiol.2262011616","article-title":"Posterior pituitary bright spot in large adenomas: MR assessment of its disappearance or relocation along the stalk","volume":"226","author":"Saeki","year":"2003","journal-title":"Radiology"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1055\/s-0039-1692484","article-title":"Carotid artery injury during transsphenoidal pituitary surgery: Lessons from a 15-year modern microsurgery cohort","volume":"81","author":"Meyer","year":"2020","journal-title":"J. Neurol. Surg. Part B Skull Base"},{"key":"ref_74","doi-asserted-by":"crossref","unstructured":"Teramoto, S., Tahara, S., Murai, Y., Sato, S., Hattori, Y., Kondo, A., and Morita, A. (2022). Injury to the extrasellar portion of the internal carotid artery during endoscopic transsphenoidal surgery: A case report. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.895233"},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Usachev, D., Sharipov, O., Abdali, A., Yakovlev, S., Lukshin, V., Kutin, M., Fomichev, D., Dorokhov, P., Bukharin, E., and Shkarubo, A. (2021). Internal carotid artery injury in transsphenoidal surgery: Tenets for its avoidance and refit\u2014A clinical study. Brain Sci., 11.","DOI":"10.3390\/brainsci11010099"},{"key":"ref_76","first-page":"1","article-title":"Carotid pseudoaneurysms after endoscopic transsphenoidal surgery for acromegaly","volume":"71","author":"Carrillo","year":"2024","journal-title":"Endocrinol. Diabetes Y Nutr."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"rjab146","DOI":"10.1093\/jscr\/rjab146","article-title":"Internal carotid artery false aneurysm as a fatal complication of transsphenoidal surgery","volume":"2021","author":"Sumislawski","year":"2021","journal-title":"J. Surg. Case Rep."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"010","DOI":"10.1055\/s-0033-1338164","article-title":"Delayed cavernous carotid artery pseudoaneurysm caused by absorbable plate following transsphenoidal surgery: Case report and review of the literature","volume":"74","author":"Tuchman","year":"2013","journal-title":"J. Neurol. Surg. Rep."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Wang, P.W., Chung, M.H., Feng, S.W., Liao, H.C., Wu, Y.C., Hueng, D.Y., Yang, Y.J., and Ju, D.T. (2023). Case report: Ruptured internal carotid artery fusiform aneurysm mimicking pituitary apoplexy after stereotactic radiosurgery. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1219372"},{"key":"ref_80","first-page":"512","article-title":"Spontaneous dissecting aneurysm of the internal carotid artery","volume":"144","author":"Hommel","year":"1988","journal-title":"Magn. Reson. Imaging. Rev. Neurol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1148\/rg.286085512","article-title":"Craniocervical arterial dissection: Spectrum of imaging findings and differential diagnosis","volume":"28","author":"Rodallec","year":"2008","journal-title":"Radiographics"},{"key":"ref_82","first-page":"007","article-title":"Giant Prolactinoma and Concomitant Internal Carotid Artery Pseudo-Aneurysm: All Stages of the Decision-Making Process","volume":"1","author":"Giorgianni","year":"2018","journal-title":"Neurosurg. Cases Rev."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"164","DOI":"10.3171\/2011.9.JNS11380","article-title":"Cerebral aneurysms with intrasellar extension: A systematic review of clinical, anatomical, and treatment characteristics: A review","volume":"116","author":"Hanak","year":"2012","journal-title":"J. Neurosurg."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"E1202","DOI":"10.1227\/01.NEU.0000360127.88741.E3","article-title":"Bilateral internal carotid artery aneurysm simulating pituitary apoplexy: Case report","volume":"65","author":"Torres","year":"2009","journal-title":"Neurosurgery"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Wijethunga, W., Dissanayake, H., Perera, S., and Katulanda, P. (2018). Intra cavernous aneurysm of internal carotid artery masquerading as a pituitary adenoma: A case report. BMC Res. Notes, 11.","DOI":"10.1186\/s13104-018-3329-2"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"180","DOI":"10.4103\/sni.sni_178_17","article-title":"Giant cavernous carotid aneurysm causing pituitary dysfunction: Pituitary function recovery with high-flow bypass","volume":"8","author":"Ono","year":"2017","journal-title":"Surg. Neurol. Int."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"701","DOI":"10.4103\/1793-5482.215760","article-title":"Unruptured internal carotid artery aneurysm associated with functional pituitary adenoma: A true association","volume":"12","author":"Satyarthee","year":"2017","journal-title":"Asian J. Neurosurg."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.diii.2014.10.003","article-title":"Imaging of cervical artery dissection","volume":"95","author":"Hassen","year":"2014","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_89","doi-asserted-by":"crossref","unstructured":"Matou\u0161ek, P., Krej\u010d\u00ed, T., Misiorzov\u00e1, E., Lipina, R., Proch\u00e1zka, V., Lubojack\u00fd, J., \u010c\u00e1balov\u00e1, L., and Kom\u00ednek, P. (2022). Internal carotid injury during skull base surgery\u2014Case report and a review of the literature. 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