Adjunctive Benefit of High-Field 3 Tesla MRI Guidance in Endoscopic Transsphenoidal Resection of Pituitary Adenoma
Introduction Pituitary adenomas (PAs) although benign, are difficult to resect intracranial tumors and their residues are associated with morbidity and reduced quality of life. Thus, gross total resection (GTR) is the goal for all PAs. Role of various modalities for better intraoperative visualizati...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Thieme Medical Publishers, Inc.
2023-03-01
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| Series: | Indian Journal of Neurosurgery |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1743267 |
| _version_ | 1797847894587342848 |
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| author | Kartik Manoj Multani Anandh Balasubramaniam Boyina Jagadeshwar Rajesh Krishna Kumar Nitin Manohar Anjani Kumar |
| author_facet | Kartik Manoj Multani Anandh Balasubramaniam Boyina Jagadeshwar Rajesh Krishna Kumar Nitin Manohar Anjani Kumar |
| author_sort | Kartik Manoj Multani |
| collection | DOAJ |
| description | Introduction Pituitary adenomas (PAs) although benign, are difficult to resect intracranial tumors and their residues are associated with morbidity and reduced quality of life. Thus, gross total resection (GTR) is the goal for all PAs. Role of various modalities for better intraoperative visualization and thus improve resection of adenoma have been tested and each have their pros and cons. The aim of this paper is to analyze adjunctive benefit of high-field 3 Tesla intraoperative magnetic resonance imaging (iMRI) in PAs resection by endoscopic transnasal transsphenoidal surgery (eTSS).
Materials and Methods A total of 50 patients who underwent iMRI-guided eTSS were included. MRI findings in preoperative, intraoperative, and 3 months postoperative stage were compared. Adjunctive value of iMRI in improving resection rates of adenoma, postoperative endocrinological outcomes, need for adjuvant radiotherapy, and postoperative cerebrospinal fluid leak rates was assessed.
Results High-field 3 Tesla iMRI helped us to detect residues in 24 (48%) patients and iMRI-guided second look surgery increased our GTR rates from initial 52 to 80% and also helped us to identify and achieve 100% GTR in intrasellar residues and parasellar residues that were medial to medial carotid tangential line. With better resection rates, need for adjuvant radiotherapy was also reduced and only 2% received adjuvant radiotherapy. Average increase in surgical time with the use of iMRI was 38.78 minutes without any side effects pertaining to prolonged surgery.
Conclusion High-field iMRI is a useful adjunct in assessment and improvement in extent of resection of PA by endoscopic transsphenoidal surgery. Also, it was found beneficial in preserving normal anatomical gland and, thus, reducing the need for postoperative adjuvant hormonal and radiation therapy. |
| first_indexed | 2024-04-09T18:18:41Z |
| format | Article |
| id | doaj.art-3b9469c269ed40aea8c999f8a0616d76 |
| institution | Directory Open Access Journal |
| issn | 2277-954X 2277-9167 |
| language | English |
| last_indexed | 2024-04-09T18:18:41Z |
| publishDate | 2023-03-01 |
| publisher | Thieme Medical Publishers, Inc. |
| record_format | Article |
| series | Indian Journal of Neurosurgery |
| spelling | doaj.art-3b9469c269ed40aea8c999f8a0616d762023-04-12T12:41:54ZengThieme Medical Publishers, Inc.Indian Journal of Neurosurgery2277-954X2277-91672023-03-01120105105810.1055/s-0042-1743267Adjunctive Benefit of High-Field 3 Tesla MRI Guidance in Endoscopic Transsphenoidal Resection of Pituitary AdenomaKartik Manoj Multani0Anandh Balasubramaniam1Boyina Jagadeshwar Rajesh2Krishna Kumar3Nitin Manohar4Anjani Kumar5Department of Neurosurgery, Yashoda Hospital, Secunderabad, Telangana, IndiaDepartment of Neurosurgery, Yashoda Hospital, Secunderabad, Telangana, IndiaDepartment of Neurosurgery, Yashoda Hospital, Secunderabad, Telangana, IndiaDepartment of Neurosurgery, Yashoda Hospital, Secunderabad, Telangana, IndiaDepartment of Anesthesia, Yashoda Hospital, Secunderabad, Telangana, IndiaDepartment of Radiodiagnosis, Yashoda Hospital, Secunderabad, Telangana, IndiaIntroduction Pituitary adenomas (PAs) although benign, are difficult to resect intracranial tumors and their residues are associated with morbidity and reduced quality of life. Thus, gross total resection (GTR) is the goal for all PAs. Role of various modalities for better intraoperative visualization and thus improve resection of adenoma have been tested and each have their pros and cons. The aim of this paper is to analyze adjunctive benefit of high-field 3 Tesla intraoperative magnetic resonance imaging (iMRI) in PAs resection by endoscopic transnasal transsphenoidal surgery (eTSS). Materials and Methods A total of 50 patients who underwent iMRI-guided eTSS were included. MRI findings in preoperative, intraoperative, and 3 months postoperative stage were compared. Adjunctive value of iMRI in improving resection rates of adenoma, postoperative endocrinological outcomes, need for adjuvant radiotherapy, and postoperative cerebrospinal fluid leak rates was assessed. Results High-field 3 Tesla iMRI helped us to detect residues in 24 (48%) patients and iMRI-guided second look surgery increased our GTR rates from initial 52 to 80% and also helped us to identify and achieve 100% GTR in intrasellar residues and parasellar residues that were medial to medial carotid tangential line. With better resection rates, need for adjuvant radiotherapy was also reduced and only 2% received adjuvant radiotherapy. Average increase in surgical time with the use of iMRI was 38.78 minutes without any side effects pertaining to prolonged surgery. Conclusion High-field iMRI is a useful adjunct in assessment and improvement in extent of resection of PA by endoscopic transsphenoidal surgery. Also, it was found beneficial in preserving normal anatomical gland and, thus, reducing the need for postoperative adjuvant hormonal and radiation therapy.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1743267pituitary adenomaendoscopic transsphenoidal surgeryintraoperative mriintraoperative adjunctsintraoperative imaging |
| spellingShingle | Kartik Manoj Multani Anandh Balasubramaniam Boyina Jagadeshwar Rajesh Krishna Kumar Nitin Manohar Anjani Kumar Adjunctive Benefit of High-Field 3 Tesla MRI Guidance in Endoscopic Transsphenoidal Resection of Pituitary Adenoma Indian Journal of Neurosurgery pituitary adenoma endoscopic transsphenoidal surgery intraoperative mri intraoperative adjuncts intraoperative imaging |
| title | Adjunctive Benefit of High-Field 3 Tesla MRI Guidance in Endoscopic Transsphenoidal Resection of Pituitary Adenoma |
| title_full | Adjunctive Benefit of High-Field 3 Tesla MRI Guidance in Endoscopic Transsphenoidal Resection of Pituitary Adenoma |
| title_fullStr | Adjunctive Benefit of High-Field 3 Tesla MRI Guidance in Endoscopic Transsphenoidal Resection of Pituitary Adenoma |
| title_full_unstemmed | Adjunctive Benefit of High-Field 3 Tesla MRI Guidance in Endoscopic Transsphenoidal Resection of Pituitary Adenoma |
| title_short | Adjunctive Benefit of High-Field 3 Tesla MRI Guidance in Endoscopic Transsphenoidal Resection of Pituitary Adenoma |
| title_sort | adjunctive benefit of high field 3 tesla mri guidance in endoscopic transsphenoidal resection of pituitary adenoma |
| topic | pituitary adenoma endoscopic transsphenoidal surgery intraoperative mri intraoperative adjuncts intraoperative imaging |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1743267 |
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