Clival Invasion on Multi-Detector CT in 390 Pituitary Macroadenomas: Correlation with Sex, Subtype and Rates of Operative Complication and Recurrence

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Fig 1.
Soft-tissue (A) and bone algorithm (B) sagittal MPR in a 55-year-old female patient with null-cell pituitary macroadenoma, producing extensive clival invasion. The tumor volume is 35.40 cm³.
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Fig 2.
Soft-tissue (A) and bone algorithm (B) sagittal MPR in a 43-year-old male patient with a null-cell pituitary macroadenoma, producing focal clival invasion (black arrow). The tumor volume is 17.02 cm³.

Table 1:

Distribution of pathologic subtypes in 390 included and 108 excluded patients

	Null-Cell	Mixed	FSH	GH	PRL	ACTH	TSH	LH	Total
Included
Female	59	30	25	19	18	12	12	7	182 (47%)
Male	83	38	16	21	15	21	9	5	208 (53%)
Total	142 (36%)	68 (17%)	41 (11%)	40 (10%)	33 (8%)	33 (8%)	21 (5%)	12 (3%)
Excluded
Female	19	10	6	7	7	4	3	1	57 (53%)
Male	20	9	8	5	4	3	1	1	51 (47%)
Total	39 (36%)	19 (18%)	14 (13%)	12 (11%)	11 (10%)	7 (6%)	4 (4%)	2 (2%)

Table 2:

Patient demographics, tumor secretory status and tumor size in 390 patients with pituitary macroadenomas

Clival Invasion	Sex			Age		Pathologic Subtype			Volume
Clival Invasion	Male	Female	χ², P Value	Mean (yr)	2 Independent-Samples t Test	Null-Cell	Secreting	χ², P Value	(mean, cm³)	Mann-Whitney Test, P Value
With	7 (1.79%)	25 (6.41%)	13.861, P < .001	49.84 ± 9.25	P = .972	23 (5.90%)	9 (2.31%)	18.937, P < .001	16.45 ± 22.18	Significant, P < .001
Without	201 (51.54%)	157 (40.26%)	13.861, P < .001	45.61 ± 12.39	P = .972	119 (30.51%)	239 (61.28%)	18.937, P < .001	4.94 ± 6.18	Significant, P < .001
Summary	208 (53.33%)	182 (46.67%)		45.78 ± 12.53		142 (36.41%)	248 (63.59%)		5.55 ± 7.43

Table 3:

Influence of clinical and pathologic factors on clival invasion

	Binary Logistic Regression			Multinomial Logistic Regression
	B-Value	OR (95%CI)	P Value	B-Value	OR (95% CI)	P Value
Age	0.029	1.030 (0.999–1.062)	.061	0.015	1.015 (0.979–1.053)	.419
Female sex	1.349	3.852 (1.548–9.585)	.004	1.286	3.620 (1.298–10.098)	.014
Null-cell subtype	1.537	4.648 (2.088–10.350)	<.001	1.067	2.907 (1.142–7.400)	.025
Large volume	0.096	1.101 (1.065–1.138)	<.001	0.078	1.081 (1.047–1.117)	<.001

Table 4:

Clinical associations of clival invasion

	Operation Approaches		Resection Extent		Operative Complications	Follow-Up		Recurrence
	Transsphenoidal	Transfrontal	Gross Total	Subtotal	Operative Complications	Cases	Period (mo)	Recurrence
Clival destruction	26/32 (81.25%)	6/32 (18.75%)	0	32	5/32 (15.63%)	14	6.78 ± 2.91	8/14 (57.14%)
Without clival destruction	330/358 (92.18%)	28/358 (7.82%)	99	259	13/358 (3.63%)	56	8.58 ± 3.16	7/56 (12.50%)
χ²	χ² = 3.142,				χ² = 7.067		P < .001^a	χ² = 10.739
P	P = .076				P = 0.008			P = .001