• Naoto Mukada, Masahiko Tosaka, Rei Yamaguchi, Yukitaka Tanaka, Ayako Takahashi, Hiroya Shimauchi-Otaki, Sho Osawa, Yoshito Tsushima, and Yuhei Yoshimoto.
• Department of Neurosurgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
• World Neurosurg. 2022 Oct 1; 166: e177e188e177-e188.

ObjectiveAsymmetric features of nonfunctioning pituitary adenoma (NFPA) are poorly understood. We investigated the asymmetry in NFPA on magnetic resonance imaging.MethodsWe reviewed preoperative magnetic resonance imaging findings of patients initially treated for NFPA. The internal carotid artery (ICA) often seemed to cause an indentation in the external shape of the tumor (i.e., the ICA notch).ResultsTwo cases with a normal pituitary gland located at the midline were excluded. The remaining 66 cases were examined. The side where the normal gland was located was defined as the normal pituitary side and the opposite side as the cavernous sinus side. The Knosp grade was significantly higher on the cavernous sinus side (P < 0.001), and the vertical distance of the ICA was significantly greater on the cavernous sinus side (P < 0.001). The ICA notch was found in 87.9% of all cases on the normal pituitary side, but in only 45.5% on the cavernous sinus side (P < 0.001). In cases with a single-side ICA notch (34 of 68), the ICA notch was found in 91.2% of cases and on the cavernous sinus side in 8.8% (P < 0.001).ConclusionsMagnetic resonance imaging of NFPA frequently shows asymmetry. The tumor does not extend laterally on the normal pituitary side but extends laterally more freely on the cavernous sinus side. The ICA notch is often found on the normal pituitary side where the position of ICA does not move. This may be useful as a preoperative sign to indicate the normal pituitary side.Copyright © 2022 Elsevier Inc. All rights reserved.

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