Intraoperative Magnetic Resonance Imaging During Endoscopic Transsphenoidal Surgery of Growth Hormone-Secreting Pituitary Adenomas

Netuka, David; Májovský, Martin; Masopust, Václav; Belšán, T.; Jakóbisiak, Marek; Kršek, Michal; Ježková, J; Hána, Václav; Beneš, Vladimı́r

doi:10.1016/j.wneu.2016.04.094

Cited by 18 publications

(8 citation statements)

References 20 publications

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“…Remission of GH secretion was 45% (13/29), which showed that even a small tumor remnant not visualized on 0.15 T iMRI was capable of GH hypersecretion. In contrast to our findings, iMRI was found favorable for complete resection of GH-secreting adenomas in a previous study ( 27 ).…”

Section: Discussioncontrasting

confidence: 99%

Intraoperative low field MRI in transsphenoidal pituitary surgery

Møller

Andersen

Pedersen

et al. 2018

Endocrine Connections

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BackgroundIntraoperative low field MRI (iMRI, 0.15 T) during transsphenoidal surgery on pituitary adenomas (PAs) may significantly improve tumor removal. However, extensive surgery can lead to pituitary hormone deficiency. Furthermore, introduction of iMRI will prolong duration of surgery, which may elevate risk of postoperative infections.MethodsOverall, 180 transsphenoidal surgeries for PAs from 2007 to 2015 were included. IMRI was available from 2011 to 2015, during this period 67/78 (86%) surgeries were with iMRI (iMRI, n = 67). A total of 113 surgeries were performed without iMRI (controls). All surgical procedures were performed by microscopic technique. Tumor size, hormonal status and vision were assessed before surgery and 3–5 months postoperatively.ResultsGross total resection (GTR), mean tumor remnant volume and ∆-volumes were comparable between iMRI and controls: 15% (10/66) vs 23% (26/109) (P = 0.17), 2.97 cm3 (0.9–5) vs 2.1 cm3 (1.6–2.6) (P = 0.3) and 4.5 cm3 (3.6–5.5) vs 5.1 cm3 (4.2–6) (P = 0.4), respectively. Duration of surgery was significantly longer during iMRI vs controls: 126 min (117–135) vs 98 min (92–103) (P < 0.001). New pituitary–adrenal deficiency in iMRI vs controls was seen in 35% (17/48) and 35% (23/66) of surgeries, respectively (P = 0.95). New thyroid deficiency was found in 33% (13/29) and 41% (28/69) and visual field deficiencies improved in 44% (19/43) and 38% (23/60) in iMRI vs controls, respectively (P > 0.1).ConclusionTumor remnant after pituitary surgery was not significantly reduced using intraoperative low field MRI. Duration of surgery was increased in iMRI, but was not associated with increased infection rate. Pituitary hormonal function and vision were comparable between iMRI and controls.

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Section: Discussioncontrasting

confidence: 99%

Intraoperative low field MRI in transsphenoidal pituitary surgery

Møller

Andersen

Pedersen

et al. 2018

Endocrine Connections

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“…Intra-operative MRI, which has been used as an adjunct to both microsurgical and endoscopic techniques, provides an early objective assessment of the radicality of tumor resection [75]. With its use, an improvement in surgical outcomes and consequent remission rates has been reported in two microsurgical and two endoscopic case series [62, 76–78]. Greater accessibility to this technology may, therefore, lead to increased application in the resection of GH-secreting pituitary adenomas.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications

et al. 2017

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“…Overall remission was achieved in 79%. Finally, Netuka et al . reported the largest series of patients with functional tumors in whom iMRI was used with the outcomes of 105 patients with acromegaly.…”

Section: Intradural Tumorsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

150

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Intraoperative Magnetic Resonance Imaging During Endoscopic Transsphenoidal Surgery of Growth Hormone-Secreting Pituitary Adenomas

Cited by 18 publications

References 20 publications

Intraoperative low field MRI in transsphenoidal pituitary surgery

Intraoperative low field MRI in transsphenoidal pituitary surgery

Microsurgical versus endoscopic transsphenoidal resection for acromegaly: a systematic review of outcomes and complications

ICAR: endoscopic skull‐base surgery

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