Publication year: 2012
Source:World Neurosurgery
Martin Hlavica, David Bellut, Doreen Lemm, Christoph Schmid, Rene Ludwig Bernays
Background Non-functioning pituitary adenomas (NFPAs) are among the most frequent intracranial neoplasms. Surgical therapy is the treatment of choice whereupon complete tumor resection should be aimed for to ensure long term tumor control. Objective The aim of this study was to analyze the impact of intraoperative ultra-low field magnetic resonance imaging on the extent of tumor resection. Methods A series of 104 consecutive cases receiving transsphenoidal iMRI-guided surgery for NFPA was retrospectively analyzed. General patient data, endocrinological parameters, neurological examinations, pre-/post-operative symptoms, pre-/post- and intraoperative imaging and the proliferation index were evaluated in an overall mean follow-up of 34 months. Results The use of iMRI lead to an increase of the overall remission rate by 52.2% from 44.2% to 67.3%. Tumor characteristics such as size and invasiveness showed an important impact on postoperative remission rate. In patients with macroadenoma and without previous pituitary surgery, a remission rate of 82.2% was achieved. Overall the sensitivity of the iMRI in the study was 32.4%. On the other hand, there was no false positive interpretation. Furthermore, we found a higher PI in the 15 patients with postoperative enlargement of residual adenomas or tumor recurrence compared to the other patients of our study group. Conclusions This study shows that the outcome of surgical treatment of NFPAs was improved by the use of iMRI due to more radical resection. The remission rate seems to be dependend on tumor characteristics. Recurrent disease might be lowered by the use of iMRI due to more complete surgical resection.
Source:World Neurosurgery
Martin Hlavica, David Bellut, Doreen Lemm, Christoph Schmid, Rene Ludwig Bernays
Background Non-functioning pituitary adenomas (NFPAs) are among the most frequent intracranial neoplasms. Surgical therapy is the treatment of choice whereupon complete tumor resection should be aimed for to ensure long term tumor control. Objective The aim of this study was to analyze the impact of intraoperative ultra-low field magnetic resonance imaging on the extent of tumor resection. Methods A series of 104 consecutive cases receiving transsphenoidal iMRI-guided surgery for NFPA was retrospectively analyzed. General patient data, endocrinological parameters, neurological examinations, pre-/post-operative symptoms, pre-/post- and intraoperative imaging and the proliferation index were evaluated in an overall mean follow-up of 34 months. Results The use of iMRI lead to an increase of the overall remission rate by 52.2% from 44.2% to 67.3%. Tumor characteristics such as size and invasiveness showed an important impact on postoperative remission rate. In patients with macroadenoma and without previous pituitary surgery, a remission rate of 82.2% was achieved. Overall the sensitivity of the iMRI in the study was 32.4%. On the other hand, there was no false positive interpretation. Furthermore, we found a higher PI in the 15 patients with postoperative enlargement of residual adenomas or tumor recurrence compared to the other patients of our study group. Conclusions This study shows that the outcome of surgical treatment of NFPAs was improved by the use of iMRI due to more radical resection. The remission rate seems to be dependend on tumor characteristics. Recurrent disease might be lowered by the use of iMRI due to more complete surgical resection.
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