 There are new postoperative findings related to transphenoidal resection of pituitary macroadenoma with intrinsic T1 shortening in the inferior aspect of the mass in the sphenoid sinus likely representing fat packing, given drop out of signal on FLAIR images, as fat saturated post-contrast images are not available. The 3-D T1 postcontrast images are not acquired inadvertently. There are minimal blood products in the mid to inferior aspect of the mass. The predominant portion of the mass still remains, with interval resection along the base and central portion of the mass. However, the overall contour and marginal extent appears unchanged at present measuring 19 x 34 mm in sagittal dimension. There is persistent mass effect on the optic chiasm, impressing upon the inferior aspect of the hypothalamus (left more than right), without significant change.There is new diffuse smooth dural enhancement which is likely postsurgical. There is no acute infarct, or midline shift. There is no suspicious intracranial enhancement elsewhere within the brain. There are scattered subcortical and periventricular white matter T2 signal abnormalities which are nonspecific, and probably represent moderate chronic microvascular ischemic changes. The ventricles and sulci are unchanged.
Expected new postoperative findings related to transphenoidal pituitary macroadenoma debulking. No significant interval change in mass effect or overall marginal extent of the mass at this time.