Intraoperative MRI during transsphenoidal surgery of pituitary macroadenomas

Matsuno A, Sasaki T, Saito N, Mochizuki T, Fujimaki T, Kirino T, Takakura K. Transcavernous surgery; an effective treatment for pituitary macroadenomas. Eur J Endocrinol 1995:133:156–65. ISSN 0804–4643 The endocrinological outcome in four patients with pituitary macroadenomas laterally invading the cavernous sinus, who were treated surgically by the transcranial transcavernous approach, was compared with that in four patients with macroadenomas that had been removed transsphenoidally. The decrease in the elevated serum levels of anterior pituitary hormones after transcavernous surgery ranged from 58.4% to 90.1%, whereas after transsphenoidal surgery it ranged from 0% to 46.1%. The responsiveness of pituitary hormones to stimulation tests was restored and maintained after transcranial transcavernous surgery. Transsphenoidal surgery achieved neither sufficient tumor reduction nor produced a satisfactory endocrinological remission. When cavernous sinus invasion is suspected by magnetic resonance imaging, even if it cannot be confirmed with certainty, transcranial transcavernous surgery is recommended. It is a useful surgical procedure for obtaining a sufficient degree of tumor extirpation and satisfactory endocrinological improvement in patients with macro-adenomas laterally invading the cavernous sinus, particularly somatotroph or corticotroph macro-adenomas. Postoperatively, mild cranial nerve paresis may occur, but this may resolve in 1–4 months. Akira Matsuno, Department of Neurosurgery, Teikyo University Ichihara Hospital, 3426-3 Anegasaki, Ichihara City, Chiba 299-01, Japan

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Intraoperative MRI and endocrinological outcome of transsphenoidal surgery for non-functioning pituitary adenoma

Acta Neurochirurgica ◽

10.1007/s00701-012-1285-5 ◽

2012 ◽

Vol 154 (4) ◽

pp. 639-647 ◽

Cited By ~ 39

Author(s):

Sven Berkmann ◽

Javier Fandino ◽

Beat Müller ◽

Luca Remonda ◽

Hans Landolt

Keyword(s):

Pituitary Adenoma ◽

Transsphenoidal Surgery ◽

Intraoperative Mri

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Residual anterior pituitary function following transsphenoidal resection of pituitary macroadenomas

Journal of Neurosurgery ◽

10.3171/jns.1984.61.3.0577 ◽

1984 ◽

Vol 61 (3) ◽

pp. 577-580 ◽

Cited By ~ 51

Author(s):

Alfred T. Nelson ◽

H. St. George Tucker ◽

Donald P. Becker

Keyword(s):

Anterior Pituitary ◽

Transsphenoidal Surgery ◽

Normal Function ◽

Pituitary Function ◽

Acceptable Risk ◽

Content Type ◽

Anterior Pituitary Function ◽

Improved Function ◽

Pituitary Macroadenomas ◽

Transsphenoidal Resection

✓ A series of 84 patients with pituitary adenomas greater than 1 cm in diameter is presented. Full preoperative and postoperative endocrine evaluations were carried out, and the effects of transsphenoidal surgery on remaining anterior pituitary function were analyzed. Of the patients who had normal anterior pituitary function before surgery, 78% retained normal function after surgery. Thirty-three percent of those patients with pituitary deficits who did not have panhypopituitarism before surgery had improved function after surgery; 33% had worsened function after surgery. None of the patients with panhypopituitarism before surgery regained function after surgery. Transsphenoidal surgery carries an acceptable risk for sacrificing anterior pituitary function, but the risk is greater in patients with larger tumors and preoperatively compromised pituitary function.

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The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the Advanced Multimodality Image Guided Operating suite

Neurosurgical FOCUS ◽

10.3171/2016.1.focus15515 ◽

2016 ◽

Vol 40 (3) ◽

pp. E18 ◽

Cited By ~ 20

Author(s):

Hasan A. Zaidi ◽

Kenneth De Los Reyes ◽

Garni Barkhoudarian ◽

Zachary N. Litvack ◽

Wenya Linda Bi ◽

...

Keyword(s):

Skull Base ◽

Residual Disease ◽

Skull Base Surgery ◽

Intraoperative Mri ◽

Gross Total Resection ◽

Inclusion Criteria ◽

Total Resection ◽

Image Guided ◽

Multimodality Image ◽

Pituitary Macroadenomas

OBJECTIVE Endoscopic skull base surgery has become increasingly popular among the skull base surgery community, with improved illumination and angled visualization potentially improving tumor resection rates. Intraoperative MRI (iMRI) is used to detect residual disease during the course of the resection. This study is an investigation of the utility of 3-T iMRI in combination with transnasal endoscopy with regard to gross-total resection (GTR) of pituitary macroadenomas. METHODS The authors retrospectively reviewed all endoscopic transsphenoidal operations performed in the Advanced Multimodality Image Guided Operating (AMIGO) suite from November 2011 to December 2014. Inclusion criteria were patients harboring presumed pituitary macroadenomas with optic nerve or chiasmal compression and visual loss, operated on by a single surgeon. RESULTS Of the 27 patients who underwent transsphenoidal resection in the AMIGO suite, 20 patients met the inclusion criteria. The endoscope alone, without the use of iMRI, would have correctly predicted extent of resection in 13 (65%) of 20 cases. Gross-total resection was achieved in 12 patients (60%) prior to MRI. Intraoperative MRI helped convert 1 STR and 4 NTRs to GTRs, increasing the number of GTRs from 12 (60%) to 16 (80%). CONCLUSIONS Despite advances in visualization provided by the endoscope, the incidence of residual disease can potentially place the patient at risk for additional surgery. The authors found that iMRI can be useful in detecting unexpected residual tumor. The cost-effectiveness of this tool is yet to be determined.

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Volumetric classification of pituitary macroadenomas predicts outcome and morbidity following endoscopic endonasal transsphenoidal surgery

Pituitary ◽

10.1007/s11102-011-0350-z ◽

2011 ◽

Vol 15 (3) ◽

pp. 450-463 ◽

Cited By ~ 57

Author(s):

Christoph P. Hofstetter ◽

Michael J. Nanaszko ◽

Lynn L. Mubita ◽

John Tsiouris ◽

Vijay K. Anand ◽

...

Keyword(s):

Transsphenoidal Surgery ◽

Endoscopic Endonasal ◽

Endoscopic Endonasal Transsphenoidal Surgery ◽

Pituitary Macroadenomas

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Toxicity Profiles of Fractionated Radiotherapy, Contemporary Stereotactic Radiosurgery, and Transsphenoidal Surgery in Nonfunctioning Pituitary Macroadenomas

Cancers ◽

10.3390/cancers11111658 ◽

2019 ◽

Vol 11 (11) ◽

pp. 1658

Author(s):

Chia-Lun Chang ◽

Kevin Sheng-Po Yuan ◽

Alexander T.H. Wu ◽

Szu-Yuan Wu

Keyword(s):

Transsphenoidal Surgery ◽

Stroke Risk ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Pituitary Macroadenoma ◽

Fractionated Radiotherapy ◽

Cox Proportional Hazards Regression ◽

Proportional Hazards Regression ◽

Group 1 ◽

Pituitary Macroadenomas

Background: Here, we compared the toxicity profiles of contemporary stereotactic radiosurgery (SRS), modern fractionated radiotherapy (FRT), and transsphenoidal surgery used to treat nonfunctioning pituitary macroadenomas. Methods: We included the data of patients with nonfunctioning pituitary macroadenomas. To compare treatment outcomes, the patients were categorized groups 1 (those receiving modern FRT), 2 (those receiving contemporary SRS), and 3 (those receiving transsphenoidal surgery). The multivariable Cox proportional hazards regression analysis was performed to yielded adjusted hazard ratios (aHRs) and their 95% CIs for local recurrence in groups 2 and 3 compared with group 1. Results: We included the data of 248 patients with nonfunctioning pituitary macroadenomas. The analytical results revealed no significant differences in second primary brain or head and neck cancer, hypopituitarism, or optic nerve injury between the three cohorts. The multivariable Cox proportional hazards regression analysis revealed that compared with group 1, the aHRs (95% CIs) for stroke risk in groups 2 and 3 were 0.37 (0.14–0.99) and 0.51 (0.31–0.84), respectively. Conclusion: Contemporary SRS and transsphenoidal surgery for nonfunctioning pituitary macroadenoma treatment have equivalent toxicity profiles. However, modern FRT for nonfunctioning pituitary macroadenoma treatment might considerably increase stroke risk.

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