Impact of Ultra-Low-Field Intraoperative Magnetic Resonance Imaging on Extent of Resection and Frequency of Tumor Recurrence in 104 Surgically Treated Nonfunctioning Pituitary Adenomas

Autor: Doreen Lemm, David Bellut, René L. Bernays, Martin Hlavica, Christoph Schmid
Přispěvatelé: University of Zurich, Bernays, René Ludwig
Rok vydání: 2013
Předmět:
Adenoma
Adult
Male
Reoperation
medicine.medical_specialty
Proliferation index
medicine.medical_treatment
10265 Clinic for Endocrinology and Diabetology
610 Medicine & health
Sensitivity and Specificity
Intraoperative MRI
10180 Clinic for Neurosurgery
Young Adult
Postoperative Complications
Pituitary adenoma
Monitoring
Intraoperative
Preoperative Care
medicine
Humans
False Positive Reactions
Pituitary Neoplasms
Aged
Retrospective Studies
Aged
80 and over
Postoperative Care
Transsphenoidal surgery
medicine.diagnostic_test
Ultra low field
business.industry
Remission Induction
Magnetic resonance imaging
Middle Aged
medicine.disease
Magnetic Resonance Imaging
2746 Surgery
Tumor recurrence
Surgery
2728 Neurology (clinical)
Treatment Outcome
Diabetes insipidus
Female
Neurology (clinical)
Radiology
Neoplasm Recurrence
Local
business
Follow-Up Studies
Zdroj: World Neurosurgery. 79:99-109
ISSN: 1878-8750
DOI: 10.1016/j.wneu.2012.05.032
Popis: Objective To analyze the impact of intraoperative ultra-low-field magnetic resonance imaging (MRI) on the extent of tumor resection in nonfunctioning pituitary adenomas (NFPAs). Methods Retrospective analysis was performed of 104 consecutive cases undergoing intraoperative MRI–guided transsphenoidal surgery for NFPA. General patient data; endocrinologic parameters; neurologic examinations; preoperative and postoperative symptoms; preoperative, intraoperative, and postoperative imaging; and proliferation index were evaluated with an overall mean follow-up of 34 months. Results The use of intraoperative MRI led to an increase of the overall remission rate by 52.2%, from 44.2% to 67.3%. Tumor characteristics such as size and invasiveness had 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 intraoperative MRI in the study was 32.4%. There were no false-positive interpretations. A higher proliferation index was found in the 15 patients with postoperative enlargement of residual adenomas or tumor recurrence compared with the other patients of the study group. Conclusions This study shows that the outcome of surgical treatment of NFPAs was improved by the use of intraoperative MRI owing to more radical resection. The remission rate seems to depend on tumor characteristics. Recurrent disease might be reduced by the use of intraoperative MRI leading to more complete surgical resection of NFPAs.
Databáze: OpenAIRE
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