Determinants of neurosurgical outcome in pituitary tumors

Barahona, María José; Sojo, L.; Wägner, Ana M.; Bartumeus, Frederic; Oliver, B.; Cano, P.; Webb, Susan M.

doi:10.1007/bf03347567

Cited by 13 publications

(8 citation statements)

References 45 publications

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“…Although GTR is not always possible, a variety of surgical tools have been introduced in transsphenoidal surgery in the last 2 decades in order incrementally to improve the degree of tumor resection. 1,4,17,18,24 The endoscope has become widely adopted in academic skull base centers to provide greater illumination of endonasal skull base structures and angled viewing, both of which are often suboptimal with a traditional microscopic view. Although most surgeons would agree that a better view should increase the potential for GTR and therefore improve clinical outcomes, this is speculative and has not been proven.…”

Section: Discussionmentioning

confidence: 99%

The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

Zaidi¹,

Reyes²,

Barkhoudarian³

et al. 2016

FOC

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OBJECTIVE Endoscopic skull base surgery has become increasingly popular among the skull base surgery community, with improved illumination and angled visualization potentially improving tumor resection rates. Intraoperative MRI (iMRI) is used to detect residual disease during the course of the resection. This study is an investigation of the utility of 3-T iMRI in combination with transnasal endoscopy with regard to gross-total resection (GTR) of pituitary macroadenomas. METHODS The authors retrospectively reviewed all endoscopic transsphenoidal operations performed in the Advanced Multimodality Image Guided Operating (AMIGO) suite from November 2011 to December 2014. Inclusion criteria were patients harboring presumed pituitary macroadenomas with optic nerve or chiasmal compression and visual loss, operated on by a single surgeon. RESULTS Of the 27 patients who underwent transsphenoidal resection in the AMIGO suite, 20 patients met the inclusion criteria. The endoscope alone, without the use of iMRI, would have correctly predicted extent of resection in 13 (65%) of 20 cases. Gross-total resection was achieved in 12 patients (60%) prior to MRI. Intraoperative MRI helped convert 1 STR and 4 NTRs to GTRs, increasing the number of GTRs from 12 (60%) to 16 (80%). CONCLUSIONS Despite advances in visualization provided by the endoscope, the incidence of residual disease can potentially place the patient at risk for additional surgery. The authors found that iMRI can be useful in detecting unexpected residual tumor. The cost-effectiveness of this tool is yet to be determined.

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Section: Discussionmentioning

confidence: 99%

The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

Zaidi¹,

Reyes²,

Barkhoudarian³

et al. 2016

FOC

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“…It allows decompression of the optimal neural structure and chances for endocrinopathy reversal. 6,[11][12][13][14][15] Although little direct evidence shows that the maximal extent of resection minimizes the risk of recurrence, the size of the original tumor has been significantly correlated to tumor recurrence. Larger tumors correlate with a higher chance of postoperative residual tumor, [16][17][18][19][20] and a higher recurrence rate.…”

Section: Discussionmentioning

confidence: 99%

Volumetric Measurement for Comparison of the Accuracy between Intraoperative CT and Postoperative MR Imaging in Pituitary Adenoma Surgery

Lee¹,

Lee²,

Chang³

et al. 2011

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:To improve the resection rate of unexpected residual pituitary tumor under image guidance, iCT provides a less time-consuming and more convenient approach of promising the safety of the trans-sphenoidal surgery. However, iCT was thought to have worse image quality than MR imaging. This study was designed to determine the predictive concordance of iCT with standard postoperative high-strength MR imaging for the detection of residual tumors.

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“…The size of the original tumor has been significantly correlated to tumor recurrence; this finding indicates that larger tumors correlate with higher chances of postopera- tive residual tumor. 2,4,12,13,27,28 The size of a residual tumor has been shown to be an independent predictor of the response to adjuvant radiation treatment, with higher remission rates for smaller lesions and radiation fields. 19,42 The minimization of residual tumor has also been associated with a delay in adjuvant radiation treatment.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,9,10,17,21,29,31,43,44 Because of the growth pattern of macroadenomas with extensions out of the surgeon's direct view through the transsphenoidal corridor, several authors have reported surprisingly high percentages of unexpected residual tumor based on intraoperative and postoperative MR imaging. 3,14,15,33,37,38 Despite its proven potential for decreasing the rates of unexpected tumor residuals, iMR imaging is infrequently used, even in the few operating environments in which such technology is available.…”

mentioning

confidence: 99%

Maximizing the extent of tumor resection during transsphenoidal surgery for pituitary macroadenomas: can endoscopy replace intraoperative magnetic resonance imaging?

Theodosopoulos¹,

Leach

Kerr³

et al. 2010

JNS

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Object. Endoscopic approaches to pituitary tumors have become an effective alternative to traditional microscopic transsphenoidal approaches. Despite a proven potential to decrease unexpected residual tumor, intraoperative MR (iMR) imaging is infrequently used even in the few operating environments in which such technology is available. Its use is prohibitive because of its cost, increased complexity, and longer operative times. The authors assessed the potential of intrasellar endoscopy to replace the need for iMR imaging without sacrificing the maximum extent of resection.Methods. In this retrospective study, 27 consecutive patients underwent fully endoscopic resection of pituitary macroadenomas. Intrasellar endoscopy was used to determine the presence of residual tumor within the sella turcica and tumor cavity. Intraoperative MR imaging was used to identify rates of unexpected residual tumor and the need for further tumor resection.Results. Intraoperative estimates of the extent of tumor resection were correct in 23 patients (85%). Of 4 patients with unacceptable tumor residuals, 3 underwent further tumor resection. After iMR imaging, the rate of successful completion of the planned extent of resection increased to 26 patients (96%). Rates of both endocrinopathy reversal and postoperative complications were consistent with previously published results for microscopic and endoscopic resection techniques.Conclusions. The findings in this study provided quantitative evidence that intrasellar endoscopy has significant promise for maximizing the extent of tumor resection and is a useful adjunct to surgical approaches to pituitary tumors, particularly when iMR imaging is unavailable. A larger prospective study on the extent of resection following endoscopic transsphenoidal surgery would strengthen these findings. (DOI: 10.3171/2009.6.JNS08916) Key woRds • intraoperative magnetic resonance imaging • intrasellar endoscopy • pituitary macroadenoma • residual tumorAbbreviations used in this paper: FOV = field of view; GTR = gross-total resection; iMR = intraoperative MR; STR = subtotal resection.

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Determinants of neurosurgical outcome in pituitary tumors

Abstract: PRL secretion, tumor size and operation date are the main predictors of neurosurgical outcome in pituitary tumors, the latter suggesting that neurosurgical experience plays an important role.

Cited by 13 publications

References 45 publications

The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

Volumetric Measurement for Comparison of the Accuracy between Intraoperative CT and Postoperative MR Imaging in Pituitary Adenoma Surgery

Maximizing the extent of tumor resection during transsphenoidal surgery for pituitary macroadenomas: can endoscopy replace intraoperative magnetic resonance imaging?

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