gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Intraoperative high-field MRI in transphenoidal surgery of HGH-producing pituitary adenomas

Intraoperative Hochfeld-MRT bei der transphenoidalen Operation von HGH sezernierenden Hypophysenadenomen

Meeting Abstract

  • corresponding author B. von Keller - Neurochirurgische Klinik, Universität Erlangen-Nürnberg
  • C. Nimsky - Neurochirurgische Klinik, Universität Erlangen-Nürnberg
  • O. Ganslandt - Neurochirurgische Klinik, Universität Erlangen-Nürnberg
  • R. Fahlbusch - Neurochirurgische Klinik, Universität Erlangen-Nürnberg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-07.03

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0022.shtml

Veröffentlicht: 4. Mai 2005

© 2005 von Keller et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

The aim of the study was to evaluate intraoperative high-field MRI in transphenoidal surgery of pituitary macroadenomas in acromegalic patients, regarding the extent of resection and endocrinological remission of acromegaly.

Methods

A 1.5 T Magnetom Sonata (Siemens Medical Solutions, Erlangen, Germany) was used for pre- and intraoperative imaging. T1, later in the study T2 weighted sequences were applied before and during surgical resection. Additional T2 weighted HASTE sequences were used for a fast image acquisition and first assessment. The surgeons’ estimate of the extent of tumour removal was documented and compared with the actual extent as evidenced by first intraoperative imaging results. Results of repeated inspections, necessary further resection, and final imaging results were also documented.

Results

From 06/02 to 05/04, 23 patients suffering from acromegaly were operated on pituitary macroadenomas by transphenoidal approach using intraoperative high-field MRI for resection control. In 21 of them, complete tumour removal was considered to be possible. HGH levels in these cases were elevated up to 74.5 ng/ml, IGF1 levels up to 1111 ng/ml. In 5 patients, intraoperative MRI led to further tumour removal, 2 of these met the consensus criteria for endocrinological remission in the 3 months postop control (HGH<1ng/ml, OGTT<1ng/ml, IGF1 normal). In another 2 patients, HGH-levels and OGTT were <2ng/ml, only IGF1 levels were slightly elevated, and in one patient HGH was <5ng/ml, OGTT<2ng/ml, IGF1 elevated. 6 patients met the consensus criteria without any further resection. Intraoperative MRI showed complete tumour removal in 17 patients, partial removal in 3 patients, and suspicious findings in another 3 patients. All patients with suspicious findings on MRI were not normalized endocrinologically.

Conclusions

Intraoperative MRI increased the rate of complete tumour removal and endocrinological normalization from 26% to 34% using the consensus criteria and improved endocrinological outcome in another 3 cases. Regarding the tumour characteristics with high initial HGH-levels, intraoperative MRI can help to achieve endocrinological remission of acromegaly in patients normally considered not to be curable. On the other side, the study showed that considering HGH as tumour marker in acromegaly, intraoperative high-field MRI is not able to detect tumour remnants in every case.