Trans-sellar Color Doppler Ultrasonography during Transsphenoidal Surgery

Arita, Kazunori; Kurisu, Kaoru; Tominaga, Atsushi; Kawamoto, Hitoshi; Iida, Koji; Mizoue, Tatsuya; Pant, Basant; Uozumi, Tohru

doi:10.1097/00006123-199801000-00016

Cited by 64 publications

(27 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, first attempts for evaluating the effects of transsphenoidal surgery starting in the 1980s, with the application of ultrasound (32,33) and computed tomography (34), were not encouraging because of the restricted quality of the intraoperative images. The development of lowfield MR scanners led to a renaissance of the idea of intraoperative imaging in transsphenoidal surgery for resection control.…”

Section: Discussionmentioning

confidence: 99%

Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging

et al. 2005

View full text Add to dashboard Cite

Objective: The aim of the study was to evaluate the effect of intraoperative high-field (1.5 Tesla) magnetic resonance imaging (MRI) on the results of transsphenoidal surgery of GH-secreting pituitary macroadenomas. Methods: Twenty-three acromegalic patients (mean tumor size, 25^12 mm; untreated preoperative GH, 4.2-159 mg/l; IGF-I, 349 -1111 mg/l) were investigated by intraoperative high-field MRI. If intraoperative imaging depicted an accessible tumor remnant, resection was continued. Results: In five patients intraoperative MRI led to further tumor removal, two of these met the consensus criteria for endocrine remission after 3 months. In two patients basal GH and oral glucose tolerance test (OGTT) were , 2 mg/l, only IGF-I was slightly elevated, and in one patient GH was , 5 mg/l and OGTT was 2 mg/l, with elevated IGF-I. Final intraoperative MRI showed no tumor remnants in 14 patients; eight of them met the consensus criteria for remission of acromegaly. In the patients with MRI showing incomplete removal (four suspect findings and five patients with intended partial removal) none was normalized. Conclusion: With regard to the patients with a tumor configuration in whom complete tumor removal was considered (n ¼ 18), intraoperative MRI increased the rate of endocrine normalization from 33 to 44% applying the consensus criteria, and improved endocrine outcome to 'nearly normalization' in another 17%. With regard to preoperative GH levels and tumor size, intraoperative MRI can help to achieve endocrine remission in patients who are normally considered not to be curable. However, taking GH as the tumor marker, even intraoperative high-field MRI was not able to detect tumor remnants in every case.

show abstract

Section: Discussionmentioning

confidence: 99%

Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Prior to opening the dura mater and whenever the surgeon thinks it is appropriate (especially while working very close to vascular structures), it is of utmost importance to use the microDoppler probe to insonate the major arteries [4,45,48,151]. The use of such a device is particularly useful while operating inside the cavernous sinus, in the retroclival prepontine area or in the suprasellar space.…”

Section: Instruments and Tools For Extended Approachesmentioning

confidence: 99%

Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery

Cappabianca

Cavallo

Esposito

et al. 2008

Advances and Technical Standards in Neurosurgery

337

189

View full text Add to dashboard Cite

“…Intraoperative ultrasound during transsphenoidal surgery has been reported by several surgical centers to be valuable in tumor localization in patients with microadenomas and extent of tumor resection in macroadenomas [88][89][90][91][92][93]. Recently, low-field intraoperative MRI was developed to facilitate assessment of extent of tumor resection before the patient is awakened from anesthesia [94][95][96].…”

Section: Advances In the Imaging Of Pediatric Pituitary Adenomasmentioning

confidence: 99%

Pituitary tumors in childhood: update of diagnosis, treatment and molecular genetics

Keil

Stratakis

2008

Expert Review of Neurotherapeutics

123

View full text Add to dashboard Cite

Pituitary tumors are rare in childhood and adolescence, with a reported prevalence of up to 1 per million children. Only 2 -6% of surgically treated pituitary tumors occur in children. Although pituitary tumors in children are almost never malignant and hormonal secretion is rare, these tumors may result in significant morbidity. Tumors within the pituitary fossa are of two types mainly, craniopharyngiomas and adenomas; craniopharyngiomas cause symptoms by compressing normal pituitary, causing hormonal deficiencies and producing mass effects on surrounding tissues and the brain; adenomas produce a variety of hormonal conditions such as hyperprolactinemia, Cushing disease and acromegaly or gigantism. Little is known about the genetic causes of sporadic lesions, which comprise the majority of pituitary tumors, but in children, more frequently than in adults, pituitary tumors may be a manifestation of genetic conditions such as multiple endocrine neoplasia type 1 (MEN 1), Carney complex, familial isolated pituitary adenoma (FIPA), and McCune-Albright syndrome. The study of pituitary tumorigenesis in the context of these genetic syndromes has advanced our knowledge of the molecular basis of pituitary tumors and may lead to new therapeutic developments.

show abstract

Trans-sellar Color Doppler Ultrasonography during Transsphenoidal Surgery

Abstract: Trans-sellar color Doppler ultrasonography seems to be a useful intraoperative guiding system that may improve the safety and efficacy of transsphenoidal surgery.

Cited by 64 publications

References 9 publications

Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging

Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging

Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery

Pituitary tumors in childhood: update of diagnosis, treatment and molecular genetics

Contact Info

Product

Resources

About