Transcranial echo-guided transsphenoidal surgical approach for the removal of large macroadenomas

Suzuki, Ryuta; Asai, Jun-ichiro; Nagashima, Goro; Itokawa, Hiroshi; Chang, C.-N.; Noda, Masayuki; Fujimoto, Michio; Fujimoto, Tsukasa

doi:10.3171/jns.2004.100.1.0068

Cited by 20 publications

(12 citation statements)

References 17 publications

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“…Furthermore, alternative effective visualization techniques like ultrasound and computed tomography must be developed further for the needs and challenges of transsphenoidal surgery. However, the suggestion of performing an additional craniotomy just for imaging purposes to monitor transsphenoidal surgery by ultrasound (38) is certainly no alternative for intraoperative MRI. Up to now, intraoperative MRI seems to be the only imaging modality that allows a reliable evaluation of pituitary adenoma removal.…”

Section: Discussionmentioning

confidence: 99%

Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging

et al. 2005

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Objective: The aim of the study was to evaluate the effect of intraoperative high-field (1.5 Tesla) magnetic resonance imaging (MRI) on the results of transsphenoidal surgery of GH-secreting pituitary macroadenomas. Methods: Twenty-three acromegalic patients (mean tumor size, 25^12 mm; untreated preoperative GH, 4.2-159 mg/l; IGF-I, 349 -1111 mg/l) were investigated by intraoperative high-field MRI. If intraoperative imaging depicted an accessible tumor remnant, resection was continued. Results: In five patients intraoperative MRI led to further tumor removal, two of these met the consensus criteria for endocrine remission after 3 months. In two patients basal GH and oral glucose tolerance test (OGTT) were , 2 mg/l, only IGF-I was slightly elevated, and in one patient GH was , 5 mg/l and OGTT was 2 mg/l, with elevated IGF-I. Final intraoperative MRI showed no tumor remnants in 14 patients; eight of them met the consensus criteria for remission of acromegaly. In the patients with MRI showing incomplete removal (four suspect findings and five patients with intended partial removal) none was normalized. Conclusion: With regard to the patients with a tumor configuration in whom complete tumor removal was considered (n ¼ 18), intraoperative MRI increased the rate of endocrine normalization from 33 to 44% applying the consensus criteria, and improved endocrine outcome to 'nearly normalization' in another 17%. With regard to preoperative GH levels and tumor size, intraoperative MRI can help to achieve endocrine remission in patients who are normally considered not to be curable. However, taking GH as the tumor marker, even intraoperative high-field MRI was not able to detect tumor remnants in every case.

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Section: Discussionmentioning

confidence: 99%

Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging

et al. 2005

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“…The infusion of air from a cervical puncture gives additional information during the visualisation of the diaphragm of the sella and may facilitate the descendens of the suprasellar portion of the tumour [13]. The use of transcranial ultrasound-guided trans-sphenoidal surgery has been reported, but it has not yet gained widespread acceptance [17, 19]. The most promising new method to facilitate the resection of pituitary adenomas is the use of an endoscope [9].…”

Section: Introductionmentioning

confidence: 99%

Intra-operative MRI facilitates tumour resection during trans-sphenoidal surgery for pituitary adenomas

Ramm‐Pettersen

Berg-Johnsen

Hol³

et al. 2011

Acta Neurochir

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BackgroundDuring trans-sphenoidal microsurgical resection of pituitary adenomas, the extent of resection may be difficult to assess, especially when extensive suprasellar and parasellar growth has occurred. In this prospective study, we investigated whether intra-operative magnetic resonance imaging (iMRI) can facilitate tumour resection.MethodsTwenty patients with macroadenomas, (16 non-functioning, three growth-hormone secreting and one pharmaco-resistant prolactinoma) were selected for surgery in the iMRI. The mean tumour diameter was 27 mm (range 11–41). The mean parasellar grade, according to the Knosp classification, was 2.3. Pre-operative coronal and sagittal T1-weighted and T2-weighted images were obtained. The trans-sphenoidal tumour resection was performed at the edge of the tunnel of a Signa SP 0.5-Tesla MRI. The surgeon aimed at a radical tumour resection that was followed by a peri-operative MRI scan. When a residual tumour was visualised and deemed resectable, an extended resection was performed, followed by another MRI scan. This procedure was repeated until the imaging results were satisfactory. In all patients, we were able to obtain images to assess the extent of resection and to classify the resection as either total or subtotal.ResultsAfter primary resection, eight out of 20 cases were classified as total resections. A second resection was performed in 11 of 12 cases classified as subtotal resections, and in four of these, total resection was achieved. A third resection was performed in three of the remaining seven cases with subtotal resections, but we did not achieve total resection in any of these cases. Therefore, the use of iMRI increased the number of patients with total resection from 8/20 (40%) to 12/20 (60%). The only observed complication was a transient spinal fluid leakage.ConclusionIntra-operative MRI during trans-sphenoidal microsurgery is useful in selected patients for a safe and more complete resection.

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“…Intraoperative ultrasound during transsphenoidal surgery has been reported by several surgical centers to be valuable in tumor localization in patients with microadenomas and extent of tumor resection in macroadenomas [88][89][90][91][92][93]. Recently, low-field intraoperative MRI was developed to facilitate assessment of extent of tumor resection before the patient is awakened from anesthesia [94][95][96].…”

Section: Advances In the Imaging Of Pediatric Pituitary Adenomasmentioning

confidence: 99%

Pituitary tumors in childhood: update of diagnosis, treatment and molecular genetics

Keil

Stratakis

2008

Expert Review of Neurotherapeutics

127

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Pituitary tumors are rare in childhood and adolescence, with a reported prevalence of up to 1 per million children. Only 2 -6% of surgically treated pituitary tumors occur in children. Although pituitary tumors in children are almost never malignant and hormonal secretion is rare, these tumors may result in significant morbidity. Tumors within the pituitary fossa are of two types mainly, craniopharyngiomas and adenomas; craniopharyngiomas cause symptoms by compressing normal pituitary, causing hormonal deficiencies and producing mass effects on surrounding tissues and the brain; adenomas produce a variety of hormonal conditions such as hyperprolactinemia, Cushing disease and acromegaly or gigantism. Little is known about the genetic causes of sporadic lesions, which comprise the majority of pituitary tumors, but in children, more frequently than in adults, pituitary tumors may be a manifestation of genetic conditions such as multiple endocrine neoplasia type 1 (MEN 1), Carney complex, familial isolated pituitary adenoma (FIPA), and McCune-Albright syndrome. The study of pituitary tumorigenesis in the context of these genetic syndromes has advanced our knowledge of the molecular basis of pituitary tumors and may lead to new therapeutic developments.

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Transcranial echo-guided transsphenoidal surgical approach for the removal of large macroadenomas

Abstract: Transcranial echo-guided transsphenoidal surgery provides real-time visualization of tumor removal. The method enhances the safety of this surgery, maximizes the removal of the tumor, and is inexpensive.

Cited by 20 publications

References 17 publications

Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging

Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging

Intra-operative MRI facilitates tumour resection during trans-sphenoidal surgery for pituitary adenomas

Pituitary tumors in childhood: update of diagnosis, treatment and molecular genetics

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