Chart 8. Postoperative follow-up of patients with residual tumor.

• Patients with small residues (intrasellar) far from the optic chiasm should be submitted to clinical follow-up (“wait and see policy”)

• The follow-up should be with annual MRI in the first 5 years. In the absence of regrowth during this period, MRI every 2-3 years

• If regrowth is detected, the approach should be individualized

• If growth is not clinically relevant and the patient remains asymptomatic with the tumor still far from the optical pathways, a new MRI should be performed in 6 months to detect whether the tumor is in progressive growth

• If the tumor growth is in progression but the patient is asymptomatic, RT should be considered. CAB can also be an option

• If the patient develops visual impairment or the tumor begins to compress visual pathways, further surgery is indicated

• Evaluation of pituitary function every 6-12 months. For patients submitted to RT, evaluation of pituitary function should be performed every 6 months

• Annual visual field perimetry should be performed in patients with tumors with suprasellar extension or those whose tumor growth reaches the optical pathways and/or determines visual impairment

MRI: magnetic resonance imaging; RT: radiotherapy; CAB: cabergoline.