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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Evaluation of intraoperative high-field MRI for resection control in elective transsphenoidal pituitary adenoma surgery: analysis of utility based on 170 consecutive patients

Meeting Abstract

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  • Karsten Geletneky - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • Venus Baba - Klinik für Neurochirurgie, Klinikum Frankfurt Höchst
  • Moritz Scherer - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • Bernhard Beigel - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • Andreas Bartsch - Abteilung Neuroradiologie, Universitätsklinikum Heidelberg
  • Andreas Unterberg - Neurochirurgische Klinik, Universitätsklinikum Heidelberg

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.09.08

doi: 10.3205/14dgnc051, urn:nbn:de:0183-14dgnc0515

Published: May 13, 2014

© 2014 Geletneky et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The goal of this study was to assess the value of intraoperative high-field MRI (1,5 Tesla) in the treatment of a large cohort of unselected patients with pituitary adenomas undergoing elective surgery via the transsphenoidal approach. The main focus of this evaluation was the potential influence of pre-operative tumor size and the assessment of the individual surgeon.

Method: From July 2009 until June 2013, intraoperative MRI (1,5 Tesla, Siemens, Germany) was performed in 170 consecutive patients (91 females, 79 males) with pituitary adenomas operated bytranssphenoidal surgery. Age distribution ranged from 9 to 88 years. 93 (54,7%) of the adenomas were hormone inactive, 77 (45,3%) revealed hormonal activity. 138 tumors (81,2%) were macroadenomas (>10 mm), 32 (18,8%) microadenomas (<10 mm). All resections were performed microscopically by an experienced (surgeon A, >200 cases) and a very experienced (surgeon B, >500 cases) neurosurgeon. MRI was performed after maximum safe resection was achieved.

Results: Intraoperative MRI lead to continuing tumor resection in 42 patients (24,7%). The frequency of further resection depended mainly on the size of the tumor. The highest rates were found in large inactive adenomas of more than 30 mm with 14/34 continuing resections (41,2%). The rate of re-resections was similar for both surgeons, irrespective of different surgical techniques. Surgeon A performed endoscopic-assisted, neuronavigation-guided resection in 115 of the patients and performed re-resections in 30 patients (26,1%), surgeon B operated 55 patients using fluoroscopic guidance and performed 12 re-resections (21,8%). There were no complications related to MR imaging and patient transport to the scanner.

Conclusions: Intraoperative high-field MRI led to secondary resections in 24,7% of 170 patients with pituitary adenomas treated by experienced neurosurgeons. IOP MRI is of particular value to improve resection of large adenomas >30mm and the rate of re-resection was similar for experienced surgeons using different surgical techniques.