The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas
The surgical treatment of recurrent adenomas can be challenging. Intraoperative magnetic resonance imaging (iMRI) can improve the orientation and increase the safe extent of resection. We conducted a quantitative and qualitative retrospective analysis of recurrent adenomas treated by endoscopic or m...
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MDPI AG
2022-01-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/29/1/35 |
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| author | Andrej Pala Andreas Knoll Max Schneider Gwendolin Etzrodt-Walter Georg Karpel-Massler Christian Rainer Wirtz Michal Hlavac |
| author_facet | Andrej Pala Andreas Knoll Max Schneider Gwendolin Etzrodt-Walter Georg Karpel-Massler Christian Rainer Wirtz Michal Hlavac |
| author_sort | Andrej Pala |
| collection | DOAJ |
| description | The surgical treatment of recurrent adenomas can be challenging. Intraoperative magnetic resonance imaging (iMRI) can improve the orientation and increase the safe extent of resection. We conducted a quantitative and qualitative retrospective analysis of recurrent adenomas treated by endoscopic or microscopic iMRI-assisted transsphenoidal surgery. A total number of 59 resections were selected. Detailed volumetric measurements, tumor characteristics, and MRI features of intraoperative remnants were evaluated. Intraoperative MRI increased the gross total resection (GTR) rate from 33.9% to 49.2%. Common locations of tumor remnants after iMRI were the clivus, the wall of the cavernous sinus or the perforation of the diaphragm. Increasing tumor volume and the microscopic technique were significantly associated with further resection after iMRI in the univariate analysis (<i>p</i> = 0.004, OR 1.6; <i>p</i> = 0.009, OR 4.4). Only the increasing tumor volume was an independent predictor for further resection (<i>p</i> = 0.007, OR 1.5). A significantly higher proportion of GTRs was achieved with the endoscopic technique (<i>p</i> = 0.001). Patients with a large recurrent pituitary adenoma who underwent microscopic transsphenoidal resection were the most likely to benefit from iMRI regarding the extent of resection. Occult invasions of the cavernous sinus and/or the clivus were the most common findings leading to further resection of tumor remnants after iMRI. |
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| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-10T01:40:31Z |
| publishDate | 2022-01-01 |
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| series | Current Oncology |
| spelling | doaj.art-8e4d2d19801b4eb487f9315403ef87372023-11-23T13:26:12ZengMDPI AGCurrent Oncology1198-00521718-77292022-01-0129139240110.3390/curroncol29010035The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary AdenomasAndrej Pala0Andreas Knoll1Max Schneider2Gwendolin Etzrodt-Walter3Georg Karpel-Massler4Christian Rainer Wirtz5Michal Hlavac6Department of Neurosurgery, University of Ulm, Lindenallee 2, 89312 Günzburg, GermanyDepartment of Neurosurgery, University of Ulm, Alber-Einsteint-Allee 23, 89081 Ulm, GermanyDepartment of Neurosurgery, University of Ulm, Lindenallee 2, 89312 Günzburg, GermanyDepartment of Endokrinology, Endokrinologiezentrum Ulm, Bahnhofplatz 7, 89073 Ulm, GermanyDepartment of Neurosurgery, University of Ulm, Alber-Einsteint-Allee 23, 89081 Ulm, GermanyDepartment of Neurosurgery, University of Ulm, Lindenallee 2, 89312 Günzburg, GermanyDepartment of Neurosurgery, University of Ulm, Lindenallee 2, 89312 Günzburg, GermanyThe surgical treatment of recurrent adenomas can be challenging. Intraoperative magnetic resonance imaging (iMRI) can improve the orientation and increase the safe extent of resection. We conducted a quantitative and qualitative retrospective analysis of recurrent adenomas treated by endoscopic or microscopic iMRI-assisted transsphenoidal surgery. A total number of 59 resections were selected. Detailed volumetric measurements, tumor characteristics, and MRI features of intraoperative remnants were evaluated. Intraoperative MRI increased the gross total resection (GTR) rate from 33.9% to 49.2%. Common locations of tumor remnants after iMRI were the clivus, the wall of the cavernous sinus or the perforation of the diaphragm. Increasing tumor volume and the microscopic technique were significantly associated with further resection after iMRI in the univariate analysis (<i>p</i> = 0.004, OR 1.6; <i>p</i> = 0.009, OR 4.4). Only the increasing tumor volume was an independent predictor for further resection (<i>p</i> = 0.007, OR 1.5). A significantly higher proportion of GTRs was achieved with the endoscopic technique (<i>p</i> = 0.001). Patients with a large recurrent pituitary adenoma who underwent microscopic transsphenoidal resection were the most likely to benefit from iMRI regarding the extent of resection. Occult invasions of the cavernous sinus and/or the clivus were the most common findings leading to further resection of tumor remnants after iMRI.https://www.mdpi.com/1718-7729/29/1/35transsphenoidal surgeryintraoperative MRIpituitary adenomaintraoperative tumor remnantcomplications |
| spellingShingle | Andrej Pala Andreas Knoll Max Schneider Gwendolin Etzrodt-Walter Georg Karpel-Massler Christian Rainer Wirtz Michal Hlavac The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas Current Oncology transsphenoidal surgery intraoperative MRI pituitary adenoma intraoperative tumor remnant complications |
| title | The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas |
| title_full | The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas |
| title_fullStr | The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas |
| title_full_unstemmed | The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas |
| title_short | The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas |
| title_sort | benefit of intraoperative magnetic resonance imaging in endoscopic and microscopic transsphenoidal resection of recurrent pituitary adenomas |
| topic | transsphenoidal surgery intraoperative MRI pituitary adenoma intraoperative tumor remnant complications |
| url | https://www.mdpi.com/1718-7729/29/1/35 |
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