Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

Berkmann, Sven; Schlaffer, Sven; Nimsky, Christopher; Fahlbusch, Rudolf; Buchfelder, Michael

doi:10.3171/2014.6.jns131994

Cited by 39 publications

(23 citation statements)

References 83 publications

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“…Further studies also show reduced operative time and complication rates . Higher rates of gross total resection with image guidance for reoperations has also been described . Tumor type, size, and prior treatments were not accounted for in the current study.…”

Section: Discussionmentioning

confidence: 65%

Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

Rizvi

Ferrandino

Luu

et al. 2018

Int Forum Allergy Rhinol

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Background:Transsphenoidal pituitary surgery has evolved into a safe procedure with shorter hospitalizations, yet unplanned readmissions remain a quality measure for which there is a paucity of data. We sought to examine rates, timing, etiologic factors, and costs surrounding readmission a er transsphenoidal pituitary surgery. Methods:The Nationwide Readmissions Database (NRD) was queried for patients who underwent transsphenoidal pituitary between January 2013 and November 2013. Patient, procedure, admission, and hospital-level characteristics were compared for patients with and without unplanned 30-day readmission. Multivariate logistic regression was used to identify readmission predictors. A total of 8546 patients were included in this retrospective study. Results:A total of 8546 patients with a median age of 54 years and female predominance were identified, with 742 patients experiencing at least 1 unplanned readmission within 30 days of index admission. Hypertension, hypothyroidism, diabetes, and obesity were common comorbidities among readmi ed patients. Readmission was most frequently because of nervous system complications, followed by neurohypophyseal or electrolyte disorders, cerebrospinal fluid leak, hemorrhage, and meningitis. Median length and cost of stay of index admission was greater in the readmission group (p < 0.001). Fluid and electrolyte disorders as well as neurologic disease (most commonly epilepsy or convulsions) present on initial admission were predictive of length of initial stay and readmission (p < 0.001). Median readmission cost was $7723 and was expected to occur within 7 days.Conclusion: Approximately 8.7% of patients undergoing transsphenoidal pituitary surgery experience an unplanned readmission within 30 days of discharge. Risk factors identified should be considered to reduce preventable readmissions and identify medically complex patients. C 2018 ARS-AAOA, LLC.

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Section: Discussionmentioning

confidence: 65%

Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

Rizvi

Ferrandino

Luu

et al. 2018

Int Forum Allergy Rhinol

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“…Studies of the iMRI-assisted treatment of sellar region tumors in adults have shown that the GTR rate for pituitary adenomas improved significantly 3,16 due to the visualization of even small tumor remnants. Intraoperative imaging has also been used for craniopharyngioma surgery, providing good early prediction of total removal and facilitating further resection of remnants.…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative imaging has also been used for craniopharyngioma surgery, providing good early prediction of total removal and facilitating further resection of remnants. 3 In our pediatric population, we performed 22 craniopharyngioma surgeries in 15 patients. We found that in 5 procedures more than 1 iMRI imaging study was performed, and in 4 of these cases it led to the visualization of tumor remnant and its removal, allowing for complete resection.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative magnetic resonance imaging in pediatric neurosurgery: safety and utility

Giordano

Samii

McLean

et al. 2017

PED

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OBJECTIVE The use of high-field intraoperative MRI has been largely studied for the treatment of intracranial tumors in adult patients. In this study, the authors investigated the safety, advantages, and limitations of high-field iMRI for cranial neurosurgical procedures in pediatric patients, with particular attention to craniopharyngiomas and gliomas. METHODS The authors performed 82 surgical procedures in patients under 16 years of age (range 0.8–15 years) over an 8-year period (2007–2014) using iMRI. The population was divided into 3 groups based on the condition treated: sellar region tumors (Group 1), gliomas (Group 2), and other pathological entities (Group 3). The patients' pre- and postoperative neurological status, the presence of residual tumor, the number of intraoperative scans, and complications were evaluated. RESULTS In Group 1, gross-total resection (GTR) was performed in 22 (88%) of the procedures and subtotal resection (STR) in 3 (12%). In Group 2, GTR, STR, and partial resection (PR) were performed, respectively, in 15 (56%), 7 (26%), and 5 (18%) of the procedures. In Group 3, GTR was performed in 28 (93%) and STR in 2 (7%) of the procedures. In cases of craniopharyngioma (Group 1) and glioma (Group 2) in which a complete removal was planned, iMRI allowed localization of residual lesions and attainment of the surgical goal through further resection, respectively, in 18% and 27% of the procedures. Moreover, in gliomas the resection could be extended from partial to subtotal in 50% of the cases. In 17% of the patients in Group 3, iMRI enabled the identification and further removal of tumor remnants. There was no intra- or postoperative complication related to the use of iMRI despite special technical difficulties in smaller children. CONCLUSIONS In this study, the use of iMRI in children proved to be safe. It was most effective in increasing the extent of tumor resection, especially in patients with low-grade gliomas and craniopharyngiomas. The most prominent disadvantage of high-field iMRI was the limitation with respect to operative positioning due to the configuration of the surgical table.

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“…Diabetes insipidus is the most common complication following pituitary adenoma surgery, and is caused by damage to the pituitary stalk, posterior pituitary, hypothalamus or the blood supply, which results in an insufficient secretion of antidiuretic hormones (26)(27)(28). The results from the present study demonstrated that postoperative complications in the bromocriptine treatment group were more prevalent than those in the group who were not treated with bromocriptine; however, the only post-operative complication that was statistically significant different in prevalence between the two groups was diabetes insipidus.…”

Section: Discussionmentioning

confidence: 99%

Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

Cao

Wang

Liu

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. Pituitary adenomas are benign intracranial endocrine tumors, accounting for ~10% of intracranial tumors. The aim of the present study was to analyze the effects of preoperative treatment with bromocriptine on the surgical treatment and postoperative complications of prolactin-secreting pituitary adenomas (prolactinomas). Data from 102 patients whose prolactinomas were surgically treated between March 2006 and March 2010 were retrospectively reviewed in the present study. The study group included 54 patients who had been treated preoperatively with bromocriptine. The patients were examined by magnetic resonance imaging (MRI) of the head and coronal computed tomography (CT) scanning, after which the pathological diagnosis of prolactinoma was confirmed. A total of 64 patients underwent total resection surgery through the nose and sphenoid sinus, and 25 patients underwent subtotal resection surgery or excision of a large portion of the tumor, leaving only a small quantity of residual tumor or tumor capsule. Patients were followed up for 1-9 months using MRI and measurements of serum prolactin levels. Seven patients were lost to follow-up. The results of the present study demonstrated that patients who were treated with large doses of bromocriptine or used bromocriptine chronically suffered from an increased rate of surgical difficulties and postoperative complications, as compared with the patents who had not been pre-treated with bromocriptine. In conclusion, oral administration of bromocriptine is important in the treatment of prolactinoma tumors. However, large doses or long-term use of bromocriptine may increase difficulties in surgery or postoperative complications, and reduce its ability to treat prolactinonas, as it can lead to hardening of the tumor tissue and capsules, and aggravate pituitary stalk adhesions.

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Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

Cited by 39 publications

References 83 publications

Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

Intraoperative magnetic resonance imaging in pediatric neurosurgery: safety and utility

Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

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