Article
The benefit of iMRI assisted endoscopic transsphenoidal approach compared to microsurgical technique in pituitary surgery
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Published: | June 9, 2017 |
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Outline
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Objective: The routine use of intraoperative MRI (iMRI) helps to achieve gross total resection (GTR) in transnasal transsphenoidal pituitary surgery. We have analyzed the added value of iMRI on extent of resection in endoscopic compared to microsurgical transsphenoidal approach and evaluated the endocrine outcome between both techniques.
Methods: A total of 96 patients with pituitary adenoma were included. A number of 28 consecutive patients underwent endoscopic transnasal transsphenoidal tumor resection. Historic cohort of 68 patients who underwent microsurgical transsphenoidal adenomectomy have been used for the analysis. We evaluated the residual tumor volume after conducting iMRI using intraoperative and late postoperative volumetric analysis 3 months after surgery. Knosp classification was used to stratify the invasive growth pattern of adenomas in cavernous sinus. Pituitary function was evaluated. Mann-Whitney-U, Fisher exact test and binary logistic regression were used for analysis.
Results: The most common histological subtype was non-functioning adenoma (N=65, 67.7%). There were significantly less additional resections after conducting iMRI in the endoscopic group (p=0.042) especially in Knosp 0-2 adenomas (p=0.029). We found no significant difference in Knosp 3-4 adenomas (p=0.520). The use of endoscopic approach was associated with smaller intraoperative tumor volume (p=0.023). There was no significant difference with regard to postoperative tumor volume between both techniques (p=0.228). No significant difference was noted with regard to surgical complications between both cohorts. Satisfactory results of pituitary function were significantly associated with an endoscopic approach (p=0.001).
Conclusion: With endoscopic approach, significantly better endocrine outcome has been achieved especially in Knosp 0-2 pituitary adenomas. Furthermore, iMRI assisted transsphenoidal endoscopic technique was associated with less intraoperative tumor volume and in less invasive adenomas with Knosp 0-2 additional resection was barely needed. In the case of extensive and invasive adenomas (Knosp 3-4) additional tumor resection and increase in the extent of resection (EoR) has been achieved by using iMRI in both groups.