Utility of 7 Tesla MRI for Preoperative Planning of Endoscopic Endonasal Surgery for Pituitary Adenomas

2019 ◽  
Author(s):  
John W. Rutland ◽  
Bradley N. Delman ◽  
Rebecca E. Feldman ◽  
Nadejda Tsankova ◽  
Hung-Mo Lin ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Field Strength ◽  
Skull Base ◽  
Cranial Nerves ◽  
Standard Of Care ◽  
7 Tesla ◽  
Endoscopic Endonasal ◽  
Magnetic Resonance Imaging Mri ◽  
Skull Base Anatomy ◽  
Ophthalmic Arteries

Abstract Object There is increasing interest in investigating the utility of 7 Tesla (7 T) magnetic resonance imaging (MRI) for imaging of skull base tumors. The present study quantifies visualization of tumor features and adjacent skull base anatomy in a homogenous cohort of pituitary adenoma patients. Methods Eighteen pituitary adenoma patients were scanned at 7 T in this prospective study. All patients had reference standard-of-care clinical imaging at either 3 T (7/18, 39%) or 1.5 T (11/18, 61%). Visualization of tumor features and conspicuity of arteries and cranial nerves (CNs) was rated by an expert neuroradiologist on 7 T and clinical field strength MRI. Overall image quality and severity of image artifacts were also characterized and compared. Results Ability to visualize tumor features did not differ between 7 T and lower field MRI. Cranial nerves III, IV, and VI were better detected at 7 T compared with clinical field strength scans. Cranial nerves III, IV, and VI were also better detected at 7 T compared with only 1.5 T, and CN III was better visualized at 7 T compared with 3 T MRI. The ophthalmic arteries and posterior communicating arteries (PCOM) were better detected at 7 T compared with clinical field strength imaging. The 7 T also provided better visualization of the ophthalmic arteries compared with 1.5 T scans. Conclusions This study demonstrates that 7 T MRI is feasible at the skull base and identifies various CNs and branches of the internal carotid artery that were better visualized at 7 T. The 7 T MRI may offer important preoperative information that can help to guide resection of pituitary adenoma and reduce operative morbidity.

scholarly journals Use of Collagen Matrix for Skull Base Reconstruction following Endoscopic Endonasal Resection of Pituitary Adenoma

2018 ◽  
Vol 79 (S 01) ◽  
pp. S1-S188
Author(s):  
Alaa Montaser ◽  
Mostafa Shahein ◽  
Juan Revuelta Barbero ◽  
Guillermo Malve ◽  
Alexandre Todeschini ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Skull Base ◽  
Collagen Matrix ◽  
Endoscopic Endonasal ◽  
Skull Base Reconstruction

Acquisition of Volumetric Models of Skull Base Anatomy Using Endoscopic Endonasal Approaches: 3D Scanning of Deep Corridors Via Photogrammetry

2019 ◽  
Vol 129 ◽  
pp. 372-377 ◽  
Author(s):  
Ioannis Kournoutas ◽  
Vera Vigo ◽  
Ricky Chae ◽  
Minghao Wang ◽  
Jose Gurrola ◽  
...  
Keyword(s):  
Skull Base ◽  
3D Scanning ◽  
Endoscopic Endonasal ◽  
Volumetric Models ◽  
Skull Base Anatomy

scholarly journals Impact of tumor characteristics and pre- and postoperative hormone levels on hormonal remission following endoscopic transsphenoidal surgery in patients with acromegaly

2020 ◽  
Vol 48 (6) ◽  
pp. E10 ◽  
Author(s):  
Tyler Cardinal ◽  
Martin J. Rutkowski ◽  
Alexander Micko ◽  
Mark Shiroishi ◽  
Chia-Shang Jason Liu ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Medical Therapy ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Cranial Nerves ◽  
Elevated Serum ◽  
Tumor Control ◽  
Tumor Diameter ◽  
Endoscopic Endonasal ◽  
Csf Leakage

OBJECTIVEAcromegaly is a disease of acral enlargement and elevated serum levels of insulin-like growth factor–1 (IGF-1) and growth hormone (GH), usually caused by a pituitary adenoma. A lack of consensus on factors that reliably predict outcomes in acromegalic patients following endoscopic endonasal transsphenoidal surgery (EETS) warrants additional investigation.METHODSThe authors identified 52 patients with acromegaly who underwent an endoscopic endonasal approach (EEA) for resection of a GH-secreting pituitary adenoma. Preoperative and postoperative tumor and endocrinological characteristics such as tumor size, invasiveness, and GH/IGF-1 levels were evaluated as potential indicators of postoperative hormonal remission. Endocrinological remission was defined as postoperative IGF-1 levels at or below the age- and sex-normalized values.RESULTSThe 52 patients had a mean age of 50.7 ± 13.4 years and a mean follow-up duration of 24.4 ± 19.1 months. Ten patients (19%) had microadenomas and 42 (81%) had macroadenomas. Five patients (9.6%) had giant adenomas. Forty-four tumors (85%) had extrasellar extension, with 40 (77%) exhibiting infrasellar invasion, 18 (35%) extending above the sella, and 7 (13%) invading the cavernous sinuses. Thirty-six patients (69%) underwent gross-total resection (GTR; mean maximal tumor diameter 1.47 cm), and 16 (31%) underwent subtotal resection (STR; mean maximal tumor diameter 2.74 cm). Invasive tumors were significantly larger, and Knosp scores were negatively correlated with GTR. Thirty-eight patients (73%) achieved hormonal remission after EEA resection alone, which increased to 87% with adjunctive medical therapy. Ninety percent of patients with microadenomas and 86% of patients with macroadenomas achieved hormonal remission. Preoperative IGF-1 and postoperative day 1 (POD1) GH levels were inversely correlated with hormonal remission. Postoperative CSF leakage occurred in 2 patients (4%), and none experienced vision loss, death, or injury to internal carotid arteries or cranial nerves.CONCLUSIONSEndoscopic transsphenoidal resection of GH-secreting pituitary adenomas is a safe and highly effective treatment for achieving hormonal remission and tumor control in up to 87% of patients with acromegaly when combined with postoperative medical therapy. Patients with lower preoperative IGF-1 and POD1 GH levels, with less invasive pituitary adenomas, and who undergo GTR are more likely to achieve postoperative biochemical remission.

Neurophysiological Identification of Cranial Nerves during Endoscopic Endonasal Surgery of Skull Base Tumors

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Alexey Shkarubo ◽  
Anna Ogurtsova ◽  
Dmitriy Moshchev ◽  
Dmitriy Andreev ◽  
Konstantin Koval ◽  
...  
Keyword(s):  
Skull Base ◽  
Cranial Nerves ◽  
Skull Base Tumors ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal

Orbitomeningeal Band in Transcavernous Dissection and Anterior Clinoidectomy: 3-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E414-E414
Author(s):  
Alvaro Campero ◽  
Matias Baldoncini ◽  
Juan F Villalonga ◽  
Amparo Sáenz
Keyword(s):  
Skull Base ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Senior Author ◽  
Microsurgical Anatomy ◽  
Resonance Imaging ◽  
Superior Orbital Fissure ◽  
3 Dimensional ◽  
Magnetic Resonance Imaging Mri ◽  
Base Lesion

Abstract The orbitomeningeal or meningo-orbital band (MOB) has been described as the most superficial dural band responsible for tethering the frontotemporal basal dura to the periorbita.1,2 The MBO usually interferes with the surgical approach to the most profound areas of the anterior and middle skull base. It is known that there are no cranial nerves on the lateral surface of the superior orbital fissure; therefore, the neurosurgeon can cut the MOB without causing any neurological deficit and, at the same time, achieving fully exposure of the anterior clinoid process1-4 and/or the lateral wall of the cavernous sinus.5 The purpose of this video is to describe the microsurgical anatomy of the MOB and illustrate the technique for its detachment, accompanied by 2 illustrative cases. To achieve this, we use 3-dimensional recordings of 2 cadaveric specimens’ dissections performed by the senior author. Case 1: 58-yr-old female with left blindness. Magnetic resonance imaging (MRI) shows an anterior and middle skull base lesion with orbital compression. Case 2: 32-yr-old male presenting with headache and trigeminal neuralgia. The MRI revealed an hourglass-shaped lesion in the posterior and middle fossa. Both patients signed an informed consent and agree with the use of their images for research purposes. We used a step-by-step approach for an adequate and secure dissection of the MOB highlighting the anatomic structures involved in the process. This approach allows safe and adequate access to the deeper structures of the anterior and middle skull base.

scholarly journals Introduction: surgical management of skull base meningiomas

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. Intro ◽  
Author(s):  
Gabriel Zada ◽  
Mustafa K Başkaya ◽  
Mitesh V. Shah
Keyword(s):  
Skull Base ◽  
Wide Spectrum ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Foramen Magnum ◽  
Surgical Approaches ◽  
Cerebrospinal Fluid Leakage ◽  
Endoscopic Endonasal ◽  
Tuberculum Sellae ◽  
Skull Base Meningiomas

Meningiomas represent the most common primary intracranial neoplasm treated by neurosurgeons. Although multimodal treatment of meningiomas includes surgery, radiation-based treatments, and occasionally medical therapy, surgery remains the mainstay of treatment for most symptomatic meningiomas. Because of the intricate relationship of the dura mater and arachnoid mater with the central nervous system and cranial nerves, meningiomas can arise anywhere along the skull base or convexities, and occasionally even within the ventricular system, thereby mandating a catalog of surgical approaches that neurosurgeons may employ to individualize treatment for patients. Skull base meningiomas represent some of the most challenging pathology encountered by neurosurgeons, on account of their depth, invasion, vascularity, texture/consistency, and their relationship to bony anatomy, cranial nerves, and blood vessels. Resection of complex skull base meningiomas often mandates adequate bony removal to achieve sufficient exposure of the tumor and surrounding region, in order to minimize brain retraction and optimally identify, protect, control, and manipulate sensitive neurovascular structures. A variety of traditional skull base approaches has evolved to address complex skull base tumors, of which meningiomas are considered the paragon in terms of both complexity and frequency.In this supplemental video issue of Neurosurgical Focus, contributing authors from around the world provide instructional narratives demonstrating resection of a variety of skull base meningiomas arising from traditionally challenging origins, including the clinoid processes, tuberculum sellae, dorsum sellae, petroclival region, falco-tentorial region, cerebellopontine angle, and foramen magnum. In addition, two cases of extended endoscopic endonasal approaches for tuberculum sellae and dorsum sellae meningiomas are presented, representing the latest evolution in accessing the skull base for selected tumors. Along with key pearls for safe tumor resection, an equally important component of open and endoscopic skull base operations for meningiomas addressed by the contributing authors is the reconstruction aspect, which must be performed meticulously to prevent delayed cerebrospinal fluid leakage and/or infections. This curated assortment of instructional videos represents the authors’ optimal treatment paradigms pertaining to the selection of approach, setup, exposure, and principles to guide tumor resection for a wide spectrum of complex meningiomas.

Neurophysiological Identification of Cranial Nerves During Endoscopic Endonasal Surgery of Skull Base Tumors: Pilot Study Technical Report

2017 ◽  
Vol 98 ◽  
pp. 230-238 ◽  
Author(s):  
Alexey Nikolaevich Shkarubo ◽  
Ilia Valerievich Chernov ◽  
Anna Anatolievna Ogurtsova ◽  
Dmitry Aleksandrovich Moshchev ◽  
Andrew Jurievich Lubnin ◽  
...  
Keyword(s):  
Pilot Study ◽  
Skull Base ◽  
Cranial Nerves ◽  
Skull Base Tumors ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal ◽  
Technical Report

Neurophysiological identification of the cranial nerves in endoscopic endonasal surgery of skull base tumors

2016 ◽  
Vol 80 (3) ◽  
pp. 35 ◽  
Author(s):  
A. N. Shkarubo ◽  
A. A. Ogurtsova ◽  
D. A. Moshchev ◽  
A. Yu. Lubnin ◽  
D. N. Andreev ◽  
...  
Keyword(s):  
Skull Base ◽  
Cranial Nerves ◽  
Skull Base Tumors ◽  
Endoscopic Endonasal Surgery ◽  
Endonasal Surgery ◽  
Endoscopic Endonasal

scholarly journals Intraoperative Neurophysiological Monitoring for Endoscopic Endonasal Approaches to the Skull Base: A Technical Guide

Scientifica ◽  
2016 ◽  
Vol 2016 ◽  
pp. 1-20
Author(s):  
Harminder Singh ◽  
Richard W. Vogel ◽  
Robert M. Lober ◽  
Adam T. Doan ◽  
Craig I. Matsumoto ◽  
...  
Keyword(s):  
Nervous System ◽  
Evoked Potentials ◽  
Skull Base ◽  
Auditory Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Cranial Nerves ◽  
Somatosensory System ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Endoscopic Endonasal

Intraoperative neurophysiological monitoring during endoscopic, endonasal approaches to the skull base is both feasible and safe. Numerous reports have recently emerged from the literature evaluating the efficacy of different neuromonitoring tests during endonasal procedures, making them relatively well-studied. The authors report on a comprehensive, multimodality approach to monitoring the functional integrity of at risk nervous system structures, including the cerebral cortex, brainstem, cranial nerves, corticospinal tract, corticobulbar tract, and the thalamocortical somatosensory system during endonasal surgery of the skull base. The modalities employed include electroencephalography, somatosensory evoked potentials, free-running and electrically triggered electromyography, transcranial electric motor evoked potentials, and auditory evoked potentials. Methodological considerations as well as benefits and limitations are discussed. The authors argue that, while individual modalities have their limitations, multimodality neuromonitoring provides a real-time, comprehensive assessment of nervous system function and allows for safer, more aggressive management of skull base tumors via the endonasal route.

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