Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Acta Neurochirurgica
Published in: Acta Neurochirurgica 3/2014

01-03-2014 | Review Article - Brain Tumors

High-Field iMRI in transsphenoidal pituitary adenoma surgery with special respect to typical localization of residual tumor

Authors: Vincenzo Paterno′, Rudolf Fahlbusch

Published in: Acta Neurochirurgica | Issue 3/2014

Login to get access

Abstract

Background

Intraoperative high-field magnetic resonance imaging (iMRI) is used as an immediate intraoperative quality control, evaluating the extent of tumor removal during the surgical procedure and allowing us to extend resections in those cases where tumor remnants are documented. The aim of the study was to analyze the typical localization of residual tumor remnants, detected by iMRI during transsphenoidal surgery of pituitary adenomas.

Methods

We reviewed a series of 72 patients. All patients presented with macroadenomas with or without suprasellar extension. After high-field MRI investigation, we divided the series preoperatively into totally resectable (TR) and non-totally resectable (NTR) tumors. Tumor remnants were documented by iMRI, obtained directly after tumor removal, as well as by intraoperative surgical inspection of the sellar content.

Results

In the TR group, we observed 23 cases suspicious for tumor remnants, located anteriorly, laterally, posteriorly, and suprasellar under descending folds of the diaphragm. Continuing surgery, upon a “second inspection”, tumor resection could be completed in all cases.

Conclusions

Incomplete removal of resectable pituitary adenomas could be avoided in a higher number of cases with the knowledge of the location of the typical remnant tumors. In those cases where it is not possible to achieve a complete resection of adenoma, further treatment can be planned at an earlier stage, without any need to wait for the conventional postoperative MRI scan performed 2 to 3 months after surgery.
Literature
1.
Arita K, Kurisu K, Tominaga A, Kawamoto H, Iida K, Mizoue T, Pant B, Uozumi T (1998) Trans-sellar color Doppler ultrasonography during transspenoidal surgery. Neurosurgery 42:81–86PubMedCrossRef
2.
Black PM, Moriarty T, Alexander E 3rd, Stieg P, Woodard EJ, Gleason PL, Martin CH, Kikinis R, Schwartz RB, Jolesz FA (1997) Development and implecementation of intraoperative magnetic resonance imaging and its neurosurgical applications. Neurosurgery 41:831–845PubMedCrossRef
3.
Bohinski RJ, Warnick RE, Gaskill-Shipley MF, Zuccarello M, van Loveren HR, Kormos DW, Tew JM Jr (2001) Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery. Neurosurgery 49:1133–1144PubMed
4.
Cappabianca P, Cavallo LM, Colao A, de Divitis E (2002) Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg 97:293–298PubMedCrossRef
5.
Dina TS, Feaster SH, Laws ER, Davis DO (1993) MR of the pituitary gland postsurgery. Serial MR studies following transsphenoidal resection. AJNR Am J Neuroradiol 14:763–769PubMed
6.
Doppman JL, Ram Z, Shawker TH, Oldfield EH (1994) Intraoperative US of the pituitary gland. Work in progress. Radiology 192:111–115PubMed
7.
Dort JC, Sutherland GR (2001) Intraoperative magnetic resonance imaging for skull base surgery. Laryngoscope 111(9):1570–1575PubMedCrossRef
8.
Elias WJ, Chadduck JB, Alden TD, Laws ER (1999) Frameless stereotaxy for transsphenoidal surgery. Neurosurgery 45:271–277PubMedCrossRef
9.
Fahlbusch R, Ganslandt O, Buchfelder M, Schott W, Nimsky C (2001) Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg 95:381–390PubMedCrossRef
10.
Fahlbusch R, Keller B, Ganslandt O, Kreutzer J, Nimsky C (2005) Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging. Eur J Endocrinol 153(2):239–248PubMedCrossRef
11.
Gerlach R, du Mesnil de Rochemont R, Gasser T, Marquardt G, Reusch J, Imoehl L, Seifert V (2008) Feasibility of Polestar N20, an Ultra-Low-Field intraoperative magnetic resonance imaging system in resection control of pituitary macroadenomas: lessons learned from the first 40 cases. Neurosurgery 63:272–285PubMedCrossRef
12.
Hardy J, Wigser SM (1965) Trans-sphenoidal surgery of pituitary fossa tumors with televised radiofluoroscopic control. J Neurosurg 23:612–619PubMedCrossRef
13.
Jane JA Jr, Thapar K, Alden TD, Laws ER Jr (2001) Fluoroscopic framless stereotaxy for transsphenoidal surgery. Neurosurgery 48:1302–1308PubMed
14.
Jho HD, Alfieri A (2001) Endoscopic endonasal pituitary surgery: evolution of surgical technique and equipment in 150 operations. Minim Invasive Neurosurg 44:1–12PubMedCrossRef
15.
Kilic T, Ekinci G, Seker A, Elmaci I, Erzen C, Pamir MN (2001) Determining optimal MRI follow-up after transsphenoidal surgery for pituitary adenoma: scan at 24 hours postsurgery provides reliable information. Acta Neurochir (Wien) 143(11):1103–1126CrossRef
16.
Knosp E, Steiner E, Kitz K, Matula C (1993) Pituitary adenomas with invasion of the cavernous sinus space: a magnetic resonance imaging classification compared with surgical findings. Neurosurgery 33:610–618PubMedCrossRef
17.
Lasio G, Ferroli P, Felisati G, Broggi G (2001) Image-guided endoscopic transnasal removal of recurrent pituitary adenoms. Neurosurgery 48:1302–1308
18.
Martin CH, Schwartz R, Jolesz F, Black PM (1999) Transsphenoidal resection of pituitary adenomas in an intraoperative MRI unit. Pituitary 2:155–162PubMedCrossRef
19.
McPherson CM, Bohinski RJ, Dagnew E, Warnick RE, Tew JM (2003) Tumor resection in a shared-resource magnetic resonance operating room: experience at the University of Cincinnati. Acta Neurochir Suppl 85:39–44PubMedCrossRef
20.
Nimsky C, Ganslandt O, von Keller B, Romstöck J, Fahlbusch R (2004) Intraoperative high-field-strenght MR imaging: implementation and experience in 200 patients. Radiology 233:67–78PubMedCrossRef
21.
Nimsky C, Ganslandt O, Fahlbusch R (2005) Comparing 0.2 Tesla with 1.5 Tesla intraoperative magnetic resonance imaging: analysis of setup, workflow and efficiency. Acad Radiol 12:1065–1079PubMedCrossRef
22.
Nimsky C, von Keller B, Ganslandt O, Fahlbusch R (2006) Intraoperative high-field magnetic resonance imaging in transsphenoidal surgery of hormonally inactive pituitary macroadenomas. Neurosurgery 59(1):105–114PubMedCrossRef
23.
Pergolizzi RS Jr, Nabavi A, Schwartz RB, Hsu L, Wong TZ, Martin C, Black PM, Jolesz FA (2001) Intra-operative MR guidance during trans-sphenoidal pituitary resection: preliminary results. J Magn Reson Imaging 13:136–141PubMedCrossRef
24.
Schulder M, Sernas T, Carmel PW (2003) Cranial surgery and navigation with a compact intraoperative MRI system. Acta Neurochir Suppl 85:79–86PubMedCrossRef
25.
Schwartz TH, Stieg PE, Anand VK (2006) Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery 58(1 Suppl):ONS44–ONS51PubMed
26.
Wolfsberger S, Ba-Ssalamah A, Pinker K, Mlynarik V, Czech T, Knosp E, Trattnig S (2004) Application of three-tesla magnetic resonance imaging for diagnosis and surgery of sellar lesions. J Neurosurg 100(2):278–286PubMedCrossRef
Metadata
Title
High-Field iMRI in transsphenoidal pituitary adenoma surgery with special respect to typical localization of residual tumor
Authors
Vincenzo Paterno′
Rudolf Fahlbusch
Publication date
01-03-2014
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 3/2014
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-013-1978-4

Other articles of this Issue 3/2014

Acta Neurochirurgica 3/2014 Go to the issue

Experimental Research - Neurosurgical Anatomy

Transcranial segment of the trigeminal nerve: macro-/microscopic anatomical study using sheet plastination

Clinical Article - Vascular

Dural arteriovenous fistulas associated with benign meningeal tumors

CLINICAL ARTICLE - FUNCTIONAL

Preoperative assessment of hemifacial spasm by the coronal heavily T2-weighted MR cisternography

Case Report - Vascular

A case of iliac artery injury treated by covered stent during carotid artery stenting

Clinical Article - Neurosurgical Anatomy

Vascular compression of the trigeminal nerve in asymptomatic individuals: a voxel-wise analysis of axial and radial diffusivity

Experimental research - Functional

Accuracy of 3D fluoroscopy in cranial stereotactic surgery: A comparative study in phantoms and patients