Article
Risk factors for additional resection after intraoperative MRI in less invasive pituitary adenomas Knosp 0-2
Risikofaktor für eine Nachresektion nach der Durchführung von iMRT in der Resektion der Hypophysenadenome Knosp 0-2
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Authors
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Michal Hlavac
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
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Andreas Knoll
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
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Gwendolin Etzrodt-Walter
- Endokrinologie Ulm, Ulm, Deutschland
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Jan Coburger
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
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Christian Rainer Wirtz
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
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Andrej Pala
- Universitätsklinik Ulm am Bezirkskrankenhaus Günzburg, Abteilung für Neurochirurgie, Standort Günzburg, Günzburg, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: We anticipated that the introduction of endoscopic technique in pituitary surgery might render our standard procedure of performing intraoperative magnetic resonance imaging (iMRI) in pituitary adenoma surgery in cases of non-invasive tumors (Knosp 0-2) redundant.
Methods: We conducted a retrospective monocenter data analysis of patients treated by iMRI assisted transsphenoidal surgery at our department between 2012 and 2020. A total number of 230 consecutive patients (surgeries) with pituitary adenomas graded as Knosp 0-2 were selected for further analysis. Of these 57.8% (N=133) were treated with microscopic 36.5% (N=84) with endoscopic and 4.3% (N=10) with endoscopic assisted technique. Volumetric measurement of preoperative, intraoperative and postoperative tumor extension was performed. Demographic data, tumor characteristics and MRI features as well as endocrine outcome were evaluated.
Results: Median preoperative tumor volume was 3.07 cm3 (ratio 0.01-18.5 cm3). Recurrent adenoma was treated in 12.6% (N=29). Apoplectic adenomas were identified in 9.6% (N=22). A total number of 48 cases (20.9%) needed additional resection after iMRI. Endoscopic approach was used in 8 of these cases. We found a significant association between additional resection and microsurgical technique (p=0.01). Multivariable logistic analysis identified tumor volume (p>0.001, OR 1.2) recurrence (p>0.001, OR 1.8) and microsurgical technique (p=0.026, OR 2.7) as independent risk factors for additional resection. The detailed analysis of adenoma remnants on iMRI after endoscopic surgery revealed the suprasellar location in a diaphragm fold or undetected invasion of cavernous sinus as the main reason for incomplete resection.
Conclusion: Tumor volume, recurrence and microsurgical technique were identified as independent predictor for additional resection in patients with less invasive adenomas Knosp 0-2. Even the endoscopic visualization of the sella turcica did not preclude tumor remnants in iMRI in our series. Tumor remnants in the endoscpic cohort were either large tumors with remnants hidden within the diaphragmic folds or behind the infiltrated wall of cavernous sinus not recognized on preoperative MRI.
