Fig. 1
Median sagittal and axial MRI sections on days 0 (before TSS) and 52 (after TSS). a MRI-T1 gadolinium angiography on day 0, median sagittal section. The pituitary gland is observed as extending beyond the dorsum sellae and up to the third ventricle, touching the optic chiasm and/or mammillary body but without touching the interthalamic adhesion. The MRI-based classification was considered to be grade III [15]. b MRI-T1 gadolinium angiography on day 0, median axial section. The pituitary-to-brain ratio was 0.61 [14], and the pituitary volume was 476 mm3, indicating enlargement of the pituitary gland. c T2-weighted MRI on day 0, median sagittal section. d T2-weighted MRI on day 0, median axial section. e Preoperative MRI-T1 gadolinium angiography on day 52, median sagittal section. The MRI-based classification was considered to be grade III. f Preoperative MRI-T1 gadolinium angiography on day 52, median axial section. The pituitary-to-brain ratio was 0.68 [14], indicating enlargement of the pituitary gland. The pituitary volume was 476 mm3. g Preoperative T2-weighted MRI on day 52, median sagittal section. Yellow arrowheads indicate multiple low-signal areas within the pituitary gland. h Preoperative T2-weighted MRI on day 52, median axial section. The yellow arrowhead indicates a low-signal area within the pituitary gland. i Preoperative T2*-weighted MRI on day 52, median axial section. Green arrowheads indicate multiple low-signal areas within the pituitary gland. j Postoperative MRI-T1 gadolinium angiography on day 52, median sagittal section. k Postoperative MRI-T1 gadolinium angiography on day 52, median axial section. The pituitary-to-brain ratio was 0.42 [14], and the pituitary volume was 168 mm3. l Postoperative T2-weighted MRI on day 52, median sagittal section. m Postoperative T2-weighted MRI on day 52, median axial section. MRI: magnetic resonance imaging, TSS: trans-sphenoidal surgery