The Mixed Sellar Barrier: a New Subtype of this Novel Concept

Abstract

BACKGROUND: The use of the recent concept of sellar barrier revealed that a specific group of patients were difficult to categorize. For this reason, we propose to add a new subtype: The mixed sellar barrier. The aim of this work is to define the new mixed barrier subtype and analyze this in a series of operated patients.

METHODS: A retrospective study was carried out. From January to December 2018, 72 patients with pituitary adenomas underwent surgery by transsphenoidal approach. Patients with more than one surgery were excluded. Each patient MRI was analyzed and classified using the following criteria: Strong barrier (greater than 1 mm), weak barrier (less than 1 mm) and mixed (less than 1 mm in one region and greater than 1 mm in another part).

RESULTS: Mixed sellar barrier is the coexistence of two types of sellar barrier (strong and weak). The presence of a mixed sellar barrier on MRI was associated with the presence of a mixed sellar barrier intraoperative (p<0.0001). By using the new MRI classification that includes the mixed sellar barrier, we found a stronger statistically significant association regarding the risk of CSF leak (for the extreme categories; i.e., strong and weak) compared to the original work.

CONCLUSION: The new mixed sellar barrier subtype was precisely defined and illustrated. The correlation between MRI and intraoperative findings for this new subtype has been demonstrated in this study. A prospective study with a larger series of patients is required for validation.