Intraoperative magnetic resonance imaging-guided transsphenoidal surgery for giant pituitary adenomas

Baumann, Fabian; Schmid, Christoph; Bernays, René-Ludwig

doi:10.1007/s10143-009-0230-4

Cited by 50 publications

(28 citation statements)

References 17 publications

(49 reference statements)

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“…The authors of a recent study [13] with focus on the early prognosis of vision were able to conclude that assessment of optic chiasm decompression by iMRI is a reliable method and that decompression of the optic pathways detected by iMRI correlates highly with prognosis of visual deficits after surgery. In the reports on visual outcome after iMRIguided transsphenoidal surgery [7,13,16,33,39,67,82,93], the recovery rates of visual symptoms were generally higher (66-100 %) than in studies without use of iMRI (48-92 %) [25, 32, 37, 42, 49-51, 75, 76, 80, 89]. Nevertheless, due to different methods in the various studies, a controlled comparison is not available.…”

Section: Discussionmentioning

confidence: 88%

Follow-up and long-term outcome of nonfunctioning pituitary adenoma operated by transsphenoidal surgery with intraoperative high-field magnetic resonance imaging

et al. 2014

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Section: Discussionmentioning

confidence: 88%

Follow-up and long-term outcome of nonfunctioning pituitary adenoma operated by transsphenoidal surgery with intraoperative high-field magnetic resonance imaging

et al. 2014

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“…Recovery rates of ophthalmological symptoms of iMRI-guided surgery in mixed populations range from 66% to 100%. 5,10,14,28,31,54,66,77 Decreased VF was reported in a total of 3 patients out of 296 who underwent iMRI-guided transsphenoidal surgery. 14,52,58 For VA decrease, a complication rate of 3% was reported for 101 iMRI-guided procedures in a mixed group of patients with sellar tumors.…”

Section: 21mentioning

confidence: 99%

“…The literature has addressed different issues, such as the feasibility and general outcome of iMRI-guided transsphenoidal surgery, 2,3,5,10,14,25,27,28,31,34,40,45,46,[49][50][51]54,[57][58][59]65,66,71,77 and special issues such as its impact on endocrinological 9 and ophthalmological 10 outcomes or its use for acromega-ly. 29 Nevertheless, the benefit of iMRI for the growing number of patients in need of repeat surgery remains unclear.…”

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confidence: 99%

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

Berkmann

Schlaffer

Nimsky

et al. 2014

JNS

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Object. The loss of anatomical landmarks, frequently invasive tumor growth, and tissue changes make transsphenoidal reoperation of nonfunctioning pituitary adenomas (NFAs) challenging. The use of intraoperative MRI (iMRI) may lead to improved results. The goal of this retrospective study was to evaluate the impact of iMRI on transsphenoidal reoperations for NFA.Methods. Between September 2002 and July 2012, 109 patients underwent reoperations in which 111 transsphenoidal procedures were performed and are represented in this study. A 1.5-T Magnetom Sonata Maestro Class scanner (Siemens) was used for iMRI. Follow-up iMRI scans were acquired if gross-total resection (GTR) was suspected or if no further removal seemed possible.Results. Surgery was performed for tumor persistence and regrowth in 26 (23%) and 85 (77%) patients, respectively. On the initial iMRI scans, GTR was confirmed in 19 (17%) patients. Remnants were located as follows: 65 in the cavernous sinus (71%), 35 in the suprasellar space (38%), 9 in the retrosellar space (10%). Additional resection was possible in 62 (67%) patients, resulting in a significant volume reduction and increased GTR rate (49%). The GTR rates of invasive tumors on initial iMRI and postoperative MRI (poMRI) were 7% and 25%, respectively. Additional remnant resection was possible in 64% of the patients. Noninvasive tumors were shown to be totally resected on the initial iMRI in 31% of cases. After additional resection for 69% of the procedures, the GTR rate on poMRI was 75%. Transcranial surgery to resect tumor remnants was indicated in 5 (5%), and radiotherapy was performed in 29 (27%) patients. After GTR, no recurrence was detected during a mean follow-up of 2.2 ± 2.1 years.Conclusions. The use of iMRI in transsphenoidal reoperations for NFA leads to significantly higher GTR rates. It thus prevents additional operations and reduces the number of tumor remnants. The complication rates do not exceed the incidences reported in the literature for primary transsphenoidal surgery. If complete tumor resection is not possible, iMRI guidance can facilitate tumor volume reduction. (http://thejns.org/doi/abs/10.3171/2014.6.JNS131994) key WorDS • pituitary adenoma • intraoperative MRI • reoperation • tumor recurrence • transsphenoidal surgery • pituitary surgeryAbbreviations used in this paper: DI = diabetes insipidus; FSH = follicle-stimulating hormone; GKS = Gamma Knife surgery; GTR = gross-total resection; iMRI = intraoperative MRI; LH = luteinizing hormone; NFA = nonfunctioning pituitary adenoma; poMRI = postoperative MRI; VA = visual acuity; VF = visual field. J Neurosurg / Volume 121 / November 2014Intraoperative MRI for transsphenoidal reoperations 1167 ly.29 Nevertheless, the benefit of iMRI for the growing number of patients in need of repeat surgery remains unclear. The aim of this retrospective study was to evaluate the impact of iMRI on the extent of transsphenoidal reoperations in patients presenting with recurrent or persisting NFA. Methods Patient Population and Data Asse...

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“…Three dimensional imaging of distorted anatomical structures and detection of residual tumor unobserved through the microscope or endoscope can improve during resection of these large adenomas. 47 …”

Section: Imri For Tssmentioning

confidence: 99%

iMRI During Transsphenoidal Surgery

Chittiboina

2017

Neurosurgery Clinics of North America

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Surgeons routinely use adjunct imaging tools during transsphenoidal surgery (TSS). Intra-operative MRI (iMRI) was quickly adopted as a surgical adjunct for TSS. Currently, a variety of iMRI systems are in use during TSS. The variations in iMRI systems include field strengths (0.15 to 3 T), magnet configurations (open, retractable, double doughnut etc.) and room configurations. Most studies report that the primary utility of iMRI during TSS lies in detecting resectable tumor residuals following maximal resection with conventional technique. Additionally, stereotaxis, neuronavigation and complication avoidance/detection are enhanced by iMRI use during TSS. The use of iMRI during TSS can lead to increased extent of resection for large tumors. Additionally, improved remission rates from hormone secreting tumors have also been reported with iMRI use. Despite increased surgical duration with iMRI, the incidence of surgical or peri-operative complications are comparable with conventional TSS. In this chapter, the history, indications and future directions for iMRI during TSS are discussed.

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Intraoperative magnetic resonance imaging-guided transsphenoidal surgery for giant pituitary adenomas

Cited by 50 publications

References 17 publications

Follow-up and long-term outcome of nonfunctioning pituitary adenoma operated by transsphenoidal surgery with intraoperative high-field magnetic resonance imaging

Follow-up and long-term outcome of nonfunctioning pituitary adenoma operated by transsphenoidal surgery with intraoperative high-field magnetic resonance imaging

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

iMRI During Transsphenoidal Surgery

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