Transsphenoidal Pituitary Macroadenomas Resection Guided by Polestar N20 Low-Field Intraoperative Magnetic Resonance Imaging

Wu, Jinsong; Shou, Xuefei; Yao, Chengjun; Wang, Yongfei; Zhuang, Dongxiao; Mao, Ying; Li, Shiqi; Zhou, Lei

doi:10.1227/01.neu.0000348549.26832.51

Cited by 64 publications

(64 citation statements)

References 40 publications

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“…The suboptimal imaging quality was evidenced by ambiguity in interpretation of several intraoperative imaging cases previously reported by our neurosurgeons and by other studies (23,(30)(31)(32)(33)(34), and by the literature's false-positive rate, which has been reported to be up to 16% for iMRI (35). Image artifacts due to drilling metal debris, hemostatic agents, or blood accumulation present additional difficulties in discerning residual tumor remnants from intraoperative changes (33,36,37). The occurrence of these unavoidable intraoperative realities can lead to incomplete resections or, even more concerning, unnecessary resection that may cause neurological comorbidities and negatively affect patient outcomes.…”

Section: Discussionmentioning

confidence: 65%

Clinical and economic outcomes of low‐field intraoperative MRI‐guided tumor resection neurosurgery

Makary

Chiocca

Erminy

et al. 2011

Magnetic Resonance Imaging

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Purpose: To compare low-field (0.15 T) intraoperative magnetic resonance imaging (iMRI)-guided tumor resection with both conventional magnetic resonance imaging (cMRI)-guided tumor resection and high-field (1.5 T) iMRI-guided resection from the clinical and economic point of view. Materials and Methods:We retrospectively compared 65 iMRI patients with 65 cMRI patients in terms of hospital length of stay, repeat resection rate, repeat resection interval, complication rate, cost to the patient, cost to the hospital, and cost effectiveness. In addition, we compared our low-field results with previously published high-field results.Results: The complication rate was lower for iMRI vs. cMRI in patients presenting for their initial tumor resection (45 vs. 57 complications, P ¼ 0.048). The iMRI repeat resection interval was longer for this cohort (20.1 vs. 6.7 months, P ¼ 0.020). iMRI was more cost-effective than cMRI for patients who had repeat resections ($10,690/ RFY vs. $76,874/RFY, P < 0.001). We found no other clinical or economic differences between iMRI-and cMRIguided tumor resection surgeries. Overall, we did not find the advantages to low-field iMRI that have been reported for high-field iMRI. Conclusion:There is no adequate justification for the widespread installation of low-field iMRI in its current development state.

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Section: Discussionmentioning

confidence: 65%

Clinical and economic outcomes of low‐field intraoperative MRI‐guided tumor resection neurosurgery

Makary

Chiocca

Erminy

et al. 2011

Magnetic Resonance Imaging

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“…Recovery rates of ophthalmological symptoms of iMRI-guided surgery in mixed populations range from 66% to 100%. 5,10,14,28,31,54,66,77 Decreased VF was reported in a total of 3 patients out of 296 who underwent iMRI-guided transsphenoidal surgery. 14,52,58 For VA decrease, a complication rate of 3% was reported for 101 iMRI-guided procedures in a mixed group of patients with sellar tumors.…”

Section: 21mentioning

confidence: 99%

“…The literature has addressed different issues, such as the feasibility and general outcome of iMRI-guided transsphenoidal surgery, 2,3,5,10,14,25,27,28,31,34,40,45,46,[49][50][51]54,[57][58][59]65,66,71,77 and special issues such as its impact on endocrinological 9 and ophthalmological 10 outcomes or its use for acromega-ly. 29 Nevertheless, the benefit of iMRI for the growing number of patients in need of repeat surgery remains unclear.…”

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confidence: 99%

Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

Berkmann

Schlaffer

Nimsky

et al. 2014

JNS

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Object. The loss of anatomical landmarks, frequently invasive tumor growth, and tissue changes make transsphenoidal reoperation of nonfunctioning pituitary adenomas (NFAs) challenging. The use of intraoperative MRI (iMRI) may lead to improved results. The goal of this retrospective study was to evaluate the impact of iMRI on transsphenoidal reoperations for NFA.Methods. Between September 2002 and July 2012, 109 patients underwent reoperations in which 111 transsphenoidal procedures were performed and are represented in this study. A 1.5-T Magnetom Sonata Maestro Class scanner (Siemens) was used for iMRI. Follow-up iMRI scans were acquired if gross-total resection (GTR) was suspected or if no further removal seemed possible.Results. Surgery was performed for tumor persistence and regrowth in 26 (23%) and 85 (77%) patients, respectively. On the initial iMRI scans, GTR was confirmed in 19 (17%) patients. Remnants were located as follows: 65 in the cavernous sinus (71%), 35 in the suprasellar space (38%), 9 in the retrosellar space (10%). Additional resection was possible in 62 (67%) patients, resulting in a significant volume reduction and increased GTR rate (49%). The GTR rates of invasive tumors on initial iMRI and postoperative MRI (poMRI) were 7% and 25%, respectively. Additional remnant resection was possible in 64% of the patients. Noninvasive tumors were shown to be totally resected on the initial iMRI in 31% of cases. After additional resection for 69% of the procedures, the GTR rate on poMRI was 75%. Transcranial surgery to resect tumor remnants was indicated in 5 (5%), and radiotherapy was performed in 29 (27%) patients. After GTR, no recurrence was detected during a mean follow-up of 2.2 ± 2.1 years.Conclusions. The use of iMRI in transsphenoidal reoperations for NFA leads to significantly higher GTR rates. It thus prevents additional operations and reduces the number of tumor remnants. The complication rates do not exceed the incidences reported in the literature for primary transsphenoidal surgery. If complete tumor resection is not possible, iMRI guidance can facilitate tumor volume reduction. (http://thejns.org/doi/abs/10.3171/2014.6.JNS131994) key WorDS • pituitary adenoma • intraoperative MRI • reoperation • tumor recurrence • transsphenoidal surgery • pituitary surgeryAbbreviations used in this paper: DI = diabetes insipidus; FSH = follicle-stimulating hormone; GKS = Gamma Knife surgery; GTR = gross-total resection; iMRI = intraoperative MRI; LH = luteinizing hormone; NFA = nonfunctioning pituitary adenoma; poMRI = postoperative MRI; VA = visual acuity; VF = visual field. J Neurosurg / Volume 121 / November 2014Intraoperative MRI for transsphenoidal reoperations 1167 ly.29 Nevertheless, the benefit of iMRI for the growing number of patients in need of repeat surgery remains unclear. The aim of this retrospective study was to evaluate the impact of iMRI on the extent of transsphenoidal reoperations in patients presenting with recurrent or persisting NFA. Methods Patient Population and Data Asse...

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“…3,12) The first uses of iMR imaging in transsphenoidal surgery for pituitary adenomas were reported around 2000, 5,20,25) and iMR imaging is now well known to be an effective and safe modality for transsphenoidal surgery of pituitary adenomas. 2,11,24,29,31,33) Detection and visualization of tumor remnants by iMR imaging contributes to an increased rate of complete tumor removal, and prevents unnecessary exploration and injury around normal tissues. 30) iMR imaging can be classified as low (0.12-0.2 tesla), medium (0.5 tesla), or high (À1.5 tesla) field according to the strength of the magnetic field used.…”

Section: Discussionmentioning

confidence: 99%

“…As a result, the use of iMR imaging increases the rate of complete tumor removal and thus prevents further unnecessary exploration. 2,10,11,24,[29][30][31]33) High-field (1.5 tesla) iMR imaging offers superior image quality to low-field (0.12-0.2 tesla) iMR imaging, and can de-…”

Section: Introductionmentioning

confidence: 99%

Use of High-Field Intraoperative Magnetic Resonance Imaging During Endoscopic Transsphenoidal Surgery for Functioning Pituitary Microadenomas and Small Adenomas Located in the Intrasellar Region

Tanei

Nagatani

Nakahara

et al. 2013

Neurol. Med. Chir.(Tokyo)

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The usefulness of 1.5-T high-field intraoperative magnetic resonance (iMR) imaging during transsphenoidal surgery for functioning pituitary adenomas was retrospectively evaluated based on longterm endocrine remission from the records of 14 patients who underwent transsphenoidal surgery with iMR imaging for functioning pituitary microadenomas and small adenomas located in the intrasellar region. The maximum tumor diameter was 9.3 ± 2.6 mm. Patients were diagnosed with acromegaly (n ＝ 7), prolactinoma (n ＝ 4), and Cushing's disease (n ＝ 3). If iMR imaging detected tumor remnants after resection, the resection cavity was reexamined and further resection was performed. Postoperative endocrine follow-up period was mean 33.7 ± 13.3 months. Tumor remnants were detected after the first resection in seven patients. Further resection was performed in five of these patients, and three achieved long-term endocrine remission. As a result, the overall long-term endocrine remission rate was 78.5% (11/14), instead of the 57.1% (8/14) that would be expected if iMR imaging had not been performed. Long-term endocrine remission had a tendency to be associated with the absence of tumor remnants on the final iMR images, but this was not significant (p ＝ 0.09). Long-term endocrine remission was associated with presence of tumor remnants in the cavernous sinus on the final iMR images (p ＝ 0.03). High-field iMR imaging is useful for depicting tumor remnants after resection, and increased the long-term endocrine remission rate for patients with functioning pituitary microadenomas and small adenomas.

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Transsphenoidal Pituitary Macroadenomas Resection Guided by Polestar N20 Low-Field Intraoperative Magnetic Resonance Imaging

Cited by 64 publications

References 40 publications

Clinical and economic outcomes of low‐field intraoperative MRI‐guided tumor resection neurosurgery

Clinical and economic outcomes of low‐field intraoperative MRI‐guided tumor resection neurosurgery

Intraoperative high-field MRI for transsphenoidal reoperations of nonfunctioning pituitary adenoma

Use of High-Field Intraoperative Magnetic Resonance Imaging During Endoscopic Transsphenoidal Surgery for Functioning Pituitary Microadenomas and Small Adenomas Located in the Intrasellar Region

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