2016
DOI: 10.3171/2015.12.focus15564
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Pituitary surgery and volumetric assessment of extent of resection: a paradigm shift in the use of intraoperative magnetic resonance imaging

Abstract: A lthough pituitary adenomas (PAs) are commonly classified as benign lesions, their clinical course is not always benign, and studies have confirmed that patients harboring a secreting adenoma have a reduced life expectancy, particularly those affected by adrenocorticotropic hormone (ACTH)-or growth hormone (GH)-secreting adenoma. 15,24,29,38,46 For such patients, endocrinological remission through gross-total resection (GTR) is the goal. Similarly, GTR is recommended for nonfunctioning pituitary adenomas (NFA… Show more

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Cited by 56 publications
(47 citation statements)
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References 53 publications
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“…Failure to establish a surgical dissection plane (as with the pseudocapsular technique) can obscure the tumor margins and leave behind remnants of isolated tumor, leading to overestimation of the extent of resection and high rates of residual tumor regardless of whether the microscope or endoscope was used. 2,4,7,13,17,20 In the current series, 10 (20%) of all intrasellar tumors without evidence of cavernous sinus invasion at surgery and with presumed gross-total resection had residual tumor at follow-up. Of those, 7 tumors were in Group A and 3 were in Group B, resulting in an overestimation of extent of resection in 41% and 9% (p < 0.05), respectively ( Table 2).…”
Section: Discussionmentioning
confidence: 47%
“…Failure to establish a surgical dissection plane (as with the pseudocapsular technique) can obscure the tumor margins and leave behind remnants of isolated tumor, leading to overestimation of the extent of resection and high rates of residual tumor regardless of whether the microscope or endoscope was used. 2,4,7,13,17,20 In the current series, 10 (20%) of all intrasellar tumors without evidence of cavernous sinus invasion at surgery and with presumed gross-total resection had residual tumor at follow-up. Of those, 7 tumors were in Group A and 3 were in Group B, resulting in an overestimation of extent of resection in 41% and 9% (p < 0.05), respectively ( Table 2).…”
Section: Discussionmentioning
confidence: 47%
“…From October 2012 onward, all patients were treated according to the same PA protocol as previously described. 20 The preoperative surgical goal for each adenoma was set based on the invasiveness pattern. Adenomas classified as Knosp grade 0, 1, or 2 were initially considered noninvasive.…”
Section: Patient Populationmentioning
confidence: 99%
“…41,63 Recent studies confirm the utility of iMRI in detecting actionable unexpected tumor residuals even in endoscopic TSS procedures. 58,64 …”
Section: Imri For Tssmentioning
confidence: 99%
“…The reports were analyzed to identify the number of unexpected residuals detected by intraoperative imaging, the number of cases that were re-explored following imaging, and finally, the number of cases where this led to further resection of residual adenoma. GE – general electric, NFPA – non-functioning pituitary adenoma, T – tesla, Ref – citation reference number, TSS – transsphenoidal surgery. Data from Refs 8, 10, 11, 2638, 40, 41, 4355, 5760, 63, 64, 75. …”
Section: Figurementioning
confidence: 99%