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

Zaidi, Hasan A.; Reyes, Kenneth De Los; Barkhoudarian, Garni; Litvack, Zachary; Bi, Wenya Linda; Rincón-Torroella, Jordina; Mukundan, Srinivasan; Dunn, Ian F.; Laws, Edward R.

doi:10.3171/2016.1.focus15515

Cited by 51 publications

(29 citation statements)

References 31 publications

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“…One potential method for maximizing tumor removal is the use of intraoperative MRI (iMRI) to assess the extent of resection. This technique has been demonstrated for nonfunctioning pituitary macroadenomas by several groups . Because remnants of macroadenomas may be difficult to visualize surgically, iMRI may reveal additional tumor that can be resected in the same setting.…”

Section: Intradural Tumorsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

139

270

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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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Section: Intradural Tumorsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

139

270

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“…As intraoperative neuronavigation has evolved over the last few decades, the consensus among neurosurgeons is that frameless CT and/or MR-based stereotaxy is superior to the previous standard using fluoroscopic guidance. 8,9 Studies have demonstrated improved total resection rates compared with nonimage-guided/fluoroscopy techniques [10][11][12] as well as improved intraoperative anatomical landmark localization in first-time operations and reoperations. 13 Together, these advantages suggest that intraoperative neuronavigation enhances the safety of neurosurgical interventions while also improving surgical outcomes (e.g., extent of resection and avoidance of complications), 14 consistent with our findings that intraoperative complications occurred solely in the non-navigation cohort at our institution.…”

Section: Intraoperative Navigationmentioning

confidence: 99%

Improved Surgical Safety via Intraoperative Navigation for Transnasal Transsphenoidal Resection of Pituitary Adenomas

et al. 2019

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Objectives Intraoperative navigation during neurosurgery can aid in the detection of critical structures and target lesions. The safety and efficacy of intraoperative, stereotactic computed tomography (CT) in the transnasal transsphenoidal resection of pituitary adenomas were explored. Design Retrospective chart review Setting Tertiary care hospital Participants Patients who underwent transsphenoidal resection of pituitary adenomas from February 2002 to May 2017. Intraoperative stereotactic CT navigation was used for all patients after mid-October 2013. Main Outcome Measures Operative time, estimated blood loss, gross total resection rate. Results Of 634 patients included, 175 underwent surgery with intraoperative navigation and 444 had no intraoperative navigation during surgery. There was no difference in mean age, sex, tumor type, or tumor size between the two groups. Operative time, endoscope use, cerebrospinal fluid diversion, and estimated blood loss were also similar. Two patients showed intraoperative, iatrogenic misdirection in the absence of stereotactic CT navigation (p = 0.99) but similar numbers of patients having navigated and non-navigated surgery returned to the operating room, underwent gross total resection, and showed endocrinological normalization. Conclusions These results suggest that intraoperative navigation can reduce injury without resulting in increased operative time, estimated blood loss, or reduction in gross total resection.

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“…Residual tumor detection with side‐facing transducers has also been reported . Although it is difficult to generalize these early results, the success of iMRI for the determination of EOR in pituitary adenoma surgery suggests that further evaluation of endonasal US imaging is warranted …”

Section: Ultrasound Applicationsmentioning

confidence: 97%

Applications of Ultrasound in the Resection of Brain Tumors

Sastry

Pieper³

et al. 2016

Journal of Neuroimaging

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117

131

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Neurosurgery makes use of pre-operative imaging to visualize pathology, inform surgical planning, and evaluate the safety of selected approaches. The utility of pre-operative imaging for neuronavigation, however, is diminished by the well characterized phenomenon of brain shift, in which the brain deforms intraoperatively as a result of craniotomy, swelling, gravity, tumor resection, cerebrospinal fluid (CSF) drainage, and many other factors. As such, there is a need for updated intraoperative information that accurately reflects intraoperative conditions. Since 1982, intraoperative ultrasound has allowed neurosurgeons to craft and update operative plans without ionizing radiation exposure or major workflow interruption. Continued evolution of ultrasound technology since its introduction has resulted in superior imaging quality, smaller probes, and more seamless integration with neuronavigation systems. Furthermore, the introduction of related imaging modalities, such as 3-dimensional ultrasound, contrast-enhanced ultrasound, high-frequency ultrasound, and ultrasound elastography have dramatically expanded the options available to the neurosurgeon intraoperatively. In the context of these advances, we review the current state, potential, and challenges of intraoperative ultrasound for brain tumor resection. We begin by evaluating these ultrasound technologies and their relative advantages and disadvantages. We then review three specific applications of these ultrasound technologies to brain tumor resection: (1) intraoperative navigation, (2) assessment of extent of resection, and (3) brain shift monitoring and compensation. We conclude by identifying opportunities for future directions in the development of ultrasound technologies.

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

Cited by 51 publications

References 31 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

Improved Surgical Safety via Intraoperative Navigation for Transnasal Transsphenoidal Resection of Pituitary Adenomas

Applications of Ultrasound in the Resection of Brain Tumors

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