Comparative Study between Neuro-navigation and Intra-Operative Ultrasound in Excision of Intra-axial Brain Lesions

Abstract Background The application of imaging during surgery can improve patient outcomes by accurate and thorough removal of lesions while having minimal impact on healthy tissue. Aim of the Work to compare the use of neuronavigation to intraoperative ultrasound guidance in excision of intra-axial brain lesion. Patients and Methods This cohort study was conducted on 51 patients with intra-axial brain lesion is amenable to gross total resection. The primary outcome was extent of resection assessed using a non-volumetric technique. Other outcomes included the postoperative functional status and the rate of operative complications. Results There were 34 patients in the Neuronavigation group and 17 patients in the ultrasound group. The extent of resection was significantly better in the ultrasound group as the extent of tumor resection based on the GTR/NTR/STR method of assessment showed that the IOUS group had statistically significant higher chance of achieving GTR (29.4%) than the navigation group (8.8%). In the IOUS group near total and subtotal resection rates were 17% and 52% respectively. In neuronavigation group 11.8% and 79.4%. Conclusion application of ultrasound integrated in Neuronavigation system guidance in surgery excision of intra-axial brain lesions is a useful tool in achieving a higher extent of tumor resection (EOR).

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Venous Thromboembolism Anticoagulation Prophylaxis Timing in Patients Undergoing Craniotomy for Tumor

Neurosurgery Open ◽

10.1093/neuopn/okaa018 ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Hanna Algattas ◽

Spencer E Talentino ◽

Bradley Eichar ◽

Abraham A Williams ◽

Joseph M Murphy ◽

...

Keyword(s):

Venous Thromboembolism ◽

Clinical Judgment ◽

Tumor Resection ◽

The Elderly ◽

Extent Of Resection ◽

Subtotal Resection ◽

Hemorrhagic Complication ◽

Increased Risk ◽

Hemorrhagic Complications ◽

Prophylactic Anticoagulation

ABSTRACT BACKGROUND Prophylactic anticoagulation helps prevent postoperative venous thromboembolism (VTE) and time to initiation postcraniotomy has relied on clinical judgment and practice patterns. OBJECTIVE To compare risks of postoperative VTE and hemorrhage among patients undergoing tumor resection with initiation of prophylactic anticoagulation on postoperative day 1 (POD1) vs POD2. METHODS Adult patients undergoing craniotomy for tumor between 2008 and 2018 were retrospectively reviewed. Outcomes were recorded from the Electronic medical record (EMR) including deep vein thrombosis (DVT), pulmonary embolism (PE), and hemorrhage. RESULTS Of a total of 1168 patients undergoing craniotomy, 225 initiated anticoagulation on POD1 and 389 initiated on POD2. Of the 171 glioblastoma (GBM) cases, 64 initiated on POD1 and 107 on POD2. There were 9 DVTs (1.5%), 1 PE (0.20%), overall VTE rate of 1.6%, and 7 hemorrhagic complications (1.10%), 4 being clinically significant. The GBM cohort contained 4 DVTs (2.3%) and 3 hemorrhagic complications (1.80%). There was no increased risk of VTE or hemorrhage with anticoagulation initiated on POD2 compared to POD1 in either cohort. Multivariate analysis in both cohorts did not reveal a significant association between DVT, PE, or hemorrhagic complications with age, body mass index, GBM pathology, or extent of resection. Interestingly, glioma patients older than 70 with subtotal resection had a higher likelihood of suffering intracranial hemorrhage when anticoagulation was started on POD1 (odds ratio 12.98). CONCLUSION Risk of VTE or hemorrhagic complication did not significantly differ with prophylactic anticoagulation started on POD1 vs POD2. Early anticoagulation may certainly be considered in high risk cases; however, 1 group where risk may outweigh benefit is the elderly glioma population receiving a subtotal resection.

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Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?

Neurosurgical FOCUS ◽

10.3171/2012.7.focus12199 ◽

2012 ◽

Vol 33 (3) ◽

pp. E16 ◽

Cited By ~ 42

Author(s):

Richard K. Gurgel ◽

Salim Dogru ◽

Richard L. Amdur ◽

Ashkan Monfared

Keyword(s):

Facial Nerve ◽

Surgical Approach ◽

Tumor Resection ◽

Extent Of Resection ◽

Vestibular Schwannomas ◽

Surgical Approaches ◽

Subtotal Resection ◽

Total Resection ◽

Translabyrinthine Approach ◽

Better Than

Object The object of this study was to evaluate facial nerve outcomes in the surgical treatment of large vestibular schwannomas (VSs; ≥ 2.5 cm maximal or extrameatal cerebellopontine angle diameter) based on both the operative approach and extent of tumor resection. Methods A PubMed search was conducted of English language studies on the treatment of large VSs published from 1985 to 2011. Studies were then evaluated and included if they contained data regarding the size of the tumor, surgical approach, extent of resection, and postoperative facial nerve function. Results Of the 536 studies initially screened, 59 full-text articles were assessed for eligibility, and 30 studies were included for analysis. A total of 1688 tumor resections were reported. Surgical approach was reported in 1390 patients and was significantly associated with facial nerve outcome (ϕ= 0.29, p < 0.0001). Good facial nerve outcomes (House-Brackmann Grade I or II) were produced in 62.5% of the 555 translabyrinthine approaches, 65.2% of the 601 retrosigmoid approaches, and 27.4% of the 234 extended translabyrinthine approaches. Facial nerve outcomes from translabyrinthine and retrosigmoid approaches were not significantly different from each other, but both showed significantly more good facial nerve outcomes, compared with the extended translabyrinthine approach (OR for translabyrinthine vs extended translabyrinthine = 4.43, 95% CI 3.17–6.19, p < 0.0001; OR for retrosigmoid vs extended translabyrinthine = 4.98, 95% CI 3.57–6.95, p < 0.0001). There were 471 patients for whom extent of resection was reported. There was a strong and significant association between degree of resection and outcome (ϕ= 0.38, p < 0.0001). Of the 80 patients receiving subtotal resections, 92.5% had good facial nerve outcomes, compared with 74.6% (n = 55) and 47.3% (n = 336) of those who received near-total resections and gross-total resections, respectively. In the 2-way comparison of good versus suboptimal/poor outcomes (House-Brackmann Grade III–VI), subtotal resection was significantly better than near-total resection (OR = 4.21, 95% CI 1.50–11.79; p = 0.004), and near-total resection was significantly better than gross-total resection (OR = 3.26, 95% CI 1.71–6.20; p = 0.0002) in producing better facial nerve outcomes. Conclusions In a pooled patient population from studies evaluating the treatment of large VSs, subtotal and near-total resections were shown to produce better facial nerve outcomes when compared with gross-total resections. The translabyrinthine and retrosigmoid surgical approaches are likely to result in similar rates of good facial nerve outcomes. Both of these approaches show better facial nerve outcomes when compared with the extended translabyrinthine approach, which is typically reserved for especially large tumors. The reported literature on treatment of large VSs is extremely heterogeneous and minimal consistency in reporting outcomes was observed.

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Prospective clinical validation of a meningioma consistency grading scheme: association with surgical outcomes and extent of tumor resection

Journal of Neurosurgery ◽

10.3171/2018.7.jns1838 ◽

2019 ◽

Vol 131 (5) ◽

pp. 1356-1360 ◽

Cited By ~ 1

Author(s):

Kyohei Itamura ◽

Ki-Eun Chang ◽

Joshua Lucas ◽

Daniel A. Donoho ◽

Steven Giannotta ◽

...

Keyword(s):

Surgical Outcomes ◽

Tumor Resection ◽

High Volume ◽

Extent Of Resection ◽

Subtotal Resection ◽

Tumor Diameter ◽

Complication Rates ◽

Duration Of Surgery ◽

Grade 3 ◽

Tumor Consistency

OBJECTIVEThe present study aims to assess the clinical utility of a previously validated intraoperative meningioma consistency grading scale and its association with extent of resection (EOR) and various surgical outcomes.METHODSThe previously validated grading system was prospectively assessed in 127 consecutive patients undergoing open craniotomy for meningioma by multiple neurosurgeons at two high-volume academic hospitals from 2013 to 2016. Consistency grading scores ranging from 1 (soft) to 5 (firm/calcified) were retrospectively analyzed to test for association with surgical outcomes and EOR, categorized as gross-total resection (GTR) or subtotal resection, defined by postoperative MRI.RESULTSOne hundred twenty-seven patients were included in the analysis with a tumor consistency distribution as follows: grade 1, 3.1%; grade 2, 14.2%; grade 3, 44.1%; grade 4, 32.3%; and grade 5, 6.3%. The mean tumor diameter was 3.6 ± 1.7 cm. Tumor consistency grades were grouped into soft (grades 1 and 2), average (grade 3), and firm (grades 4 and 5) groups for statistical analysis with distributions of 17.3%, 44.1%, and 38.6%, respectively. There was no association between meningioma consistency and maximal tumor diameter, or location. Mean duration of surgery was longer for tumors with higher consistency: grades 1 and 2, 186 minutes; grade 3, 219 minutes; and grades 4 and 5, 299 minutes (p = 0.000028). There was a trend toward higher perioperative complication rates for tumors of increased consistency: grades 1 and 2, 4.5%; grade 3, 7.0%; and grades 4 and 5, 20.8% (p = 0.047). The proportion of GTR for each consistency group was as follows: grades 1 and 2, 77%; grade 3, 68%; and grades 4 and 5, 43% (p = 0.0062).CONCLUSIONSIn addition to other important meningioma characteristics such as invasiveness, tumor consistency is a key determinant of surgical outcomes, including operative duration and EOR. Future studies predicting tumor consistency based on preoperative neuroimaging will help considerably with preoperative planning for meningiomas.

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Pre- and Intraoperative Tractographic Evaluation of Corticospinal Tract Shift

Neurosurgery ◽

10.1227/neu.0b013e31821a8555 ◽

2011 ◽

Vol 69 (3) ◽

pp. 696-705 ◽

Cited By ~ 32

Author(s):

Andrea Romano ◽

Giancarlo D'Andrea ◽

Luigi Fausto Calabria ◽

Valeria Coppola ◽

Camilla Rossi Espagnet ◽

...

Keyword(s):

Corticospinal Tract ◽

Diffusion Tensor ◽

Tumor Resection ◽

Brain Lesions ◽

Peritumoral Edema ◽

Brain Shift ◽

Neuronavigation System ◽

Dural Opening ◽

Glioma Resection ◽

The Brain

Abstract BACKGROUND: Magnetic resonance with diffusion tensor image (DTI) may be able to estimate trajectories compatible with subcortical tracts close to brain lesions. A limit of DTI is brain shifting (movement of the brain after dural opening and tumor resection). OBJECTIVE: To calculate the brain shift of trajectories compatible with the corticospinal tract (CST) in patients undergoing glioma resection and predict the shift directions of CST. METHODS: DTI was acquired in 20 patients and carried out through 12 noncollinear directions. Dedicated software “merged” all sequences acquired with tractographic processing and the whole dataset was sent to the neuronavigation system. Preoperative, after dural opening (in 11) and tumor resection (in all) DTI acquisitions were performed to evaluate CST shifting. The extent of shifting was considered as the maximum distance between the preoperative and intraoperative contours of the trajectories. RESULTS: An outward shift of CST was observed in 8 patients and an inward shift in 10 patients during surgery. In the remaining 2 patients, no intraoperative displacement was detected. Only peritumoral edema showed a statistically significant correlation with the amount of shift. In those patients in which DTI was acquired after dural opening as well (11 patients), an outward shifting of CST was evident in that phase. CONCLUSION: The use of intraoperative DTI demonstrated brain shifting of the CST. DTI evaluation of white matter tracts can be used during surgical procedures only if updated with intraoperative acquisitions.

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SURG-12. PREDICTORS OF SURVIVAL AND UTILITY OF INTRAOPERATIVE MRI FOR RESECTION OF GRADE II ASTROCYTOMAS AND OLIGODENDROGLIOMAS: A MULTICENTER ANALYSIS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.859 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii205-ii206

Author(s):

Alexander Yahanda ◽

Bhuvic Patel ◽

Amar Shah ◽

Daniel Cahill ◽

Garnette Sutherland ◽

...

Keyword(s):

Tumor Resection ◽

Progression Free Survival ◽

Extent Of Resection ◽

Intraoperative Mri ◽

Patient Treatment ◽

Subtotal Resection ◽

Related Factors ◽

Kaplan Meier ◽

Grade Ii ◽

The Impact

Abstract BACKGROUND Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative MRI (iMRI) in the resection of grade II gliomas. We assessed the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly-diagnosed grade II astrocytomas and oligodendrogliomas. METHODS Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS/PFS. RESULTS 232 resections (112 astrocytomas, 120 oligodendrogliomas; 135 males; mean age 36.2 ± 0.9 years) were analyzed. Oligodendrogliomas had longer OS (p< 0.001) and PFS (p=0.009) than astrocytomas. Multivariate regression showed that extent of resection (EOR), including gross-total (GTR) versus near-total (NTR) resection (p=0.02, HR: 0.64, 95% CI: 0.25-.79) and GTR versus subtotal resection (STR) (p=0.006, HR: 0.23, 95% CI: 0.08-0.66), was associated with longer OS. GTR versus NTR (p=0.04, HR: 0.49, 95% CI: 0.29-.85), GTR versus STR (p=0.02, HR: .54, 95% CI: .32-.91) and iMRI use (p=0.02, HR: 0.54, 95% CI: 0.32-0.92) were associated with longer PFS. Frontal (p=0.048, HR: 2.11, 95% CI: 1.01-4.43) and occipital/parietal (p=0.003, HR: 3.59, 95% CI: 1.52-8.49) locations were associated with shorter PFS (versus temporal). Kaplan-Meier analyses showed longer OS with increasing EOR (p=0.03) and 1p/19q gene deletions (p=0.02). PFS improved with increasing EOR (p=0.01), GTR versus NTR (p=0.02), and resections above STR (p=0.04). Factors influencing adjuvant treatment (35.3% of patients) included age (p=0.002, OR: 1.04) and EOR (p=0.037, OR: 0.41 for NTR versus STR; p=0.003, OR: 0.39 for GTR versus STR), but not glioma subtype or location, as determined by logistic regression. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these cases. CONCLUSIONS EOR significantly improves OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.

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Utility of Intraoperative Ultrasound in Neurosurgery

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1722243 ◽

2021 ◽

Author(s):

Gustavo Enrique Faria Méndez ◽

César José Roa Chacón ◽

Nafxiel Jesus Brito Núñez ◽

José Ramón Zerpa

Keyword(s):

Ultrasound Guidance ◽

Parietal Lobe ◽

Brain Lesion ◽

Tumor Resection ◽

Intraoperative Ultrasound ◽

Neurosurgical Procedures ◽

Neurosurgical Department ◽

Male Predominance ◽

Ultrasound Evaluation ◽

Dural Opening

Abstract Objective The purpose of the present study is to demonstrate the usefulness of intraoperative ultrasound guidance as a technique for the assessment, in real time, of tumor resection and as a navigation aid during intra-axial brain lesion removal on patients admitted in the Neurosurgical Department at the Hospital Universitario de Caracas, Caracas, Venezuela, in 2018. Methods A total of 10 patients were enrolled, each with intra-axial brain lesions with no previous neurosurgical procedures and a mean age of 49 years old, ranging from 29 to 59 years old. Results A male predominance was observed with 7 cases (70%) over 3 female cases (30%). Six patients had lesions in the dominant hemisphere. The frontal lobe was the most commonly affected, with 5 cases, followed by the parietal lobe, with 4 cases. After craniotomy, ultrasound evaluation was performed previously to dural opening, during tumor resection and after tumor removal. The mean tumor size in axial, coronal and sagittal views was 3.72 cm, 3.08 cm and 3.00 cm, respectively, previously to dural opening with intraoperative ultrasound. The average tumor depth was 1.73 cm from the cerebral cortex. The location and removal duration from the beginning of the approach (ultrasound usage time) was 83.60 minutes, and the average surgery duration was 201 minutes. Navigation with intraoperative ultrasound served to resect intra-axial tumors more precisely and safely. There was no postoperative complication associated with the surgery in this series of cases. Conclusions Intraoperative ultrasound guidance for intra-axial subcortical tumor resection is a technique that serves as a surgical and anatomical orientation tool.

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Correlation between intraoperative ultrasound and postoperative MRI in pediatric tumor surgery

Journal of Neurosurgery Pediatrics ◽

10.3171/2016.5.peds15739 ◽

2016 ◽

Vol 18 (5) ◽

pp. 578-584 ◽

Cited By ~ 8

Author(s):

Heather Smith ◽

AmiLyn Taplin ◽

Sohail Syed ◽

Matthew A. Adamo

Keyword(s):

Real Time ◽

Negative Predictive Value ◽

Predictive Value ◽

Tumor Resection ◽

Intraoperative Ultrasound ◽

Extent Of Resection ◽

Tumor Surgery ◽

Resection Rate ◽

Total Resection ◽

Postoperative Mri

OBJECTIVE Malignant disease of the CNS is the primary etiology for deaths resulting from cancer in the pediatric population. It has been well documented that outcomes of pediatric neurosurgery rely on the extent of tumor resection. Therefore, techniques that improve surgical results have significant clinical implications. Intraoperative ultrasound (IOUS) offers real-time surgical guidance and a more accurate means for detecting residual tumor that is inconspicuous to the naked eye. The objective of this study was to evaluate the correlation of extent of resection between IOUS and postoperative MRI. The authors measured the correlation of extent of resection, negative predictive value, and sensitivity of IOUS and compared them with those of MRI. METHODS This study consisted of a retrospective review of the medical charts of all pediatric patients who underwent neurosurgical treatment of a tumor between August 2009 and July 2015 at Albany Medical Center. Included were patients who were aged ≤ 21 years, who underwent brain or spinal tumor resection, for whom IOUS was used during the tumor resection, and for whom postoperative MRI (with and without contrast) was performed within 1 week of surgery. RESULTS Sixty-two patients met inclusion criteria for the study (33 males, mean age 10.0 years). The IOUS results very significantly correlated with postoperative MRI results (φ = 0.726; p = 0.000000011; negative predictive value 86.3% [95% CI 73.7%–94.3%]). These results exemplify a 71% overall gross-total resection rate and 80% intended gross-total resection rate with the use of IOUS (i.e., excluding cases performed only for debulking purposes). CONCLUSIONS The use of IOUS may play an important role in achieving a greater extent of resection by providing real-time information on tumor volume and location in the setting of brain shift throughout the course of an operation. The authors support the use of IOUS in pediatric CNS tumor surgery to improve clinical outcomes at low cost with minimal additional operating-room time and no identified additional risk.

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Coplanar Indirect-Navigated Intraoperative Ultrasound: Matching Un-navigated Probes With Neuronavigation During Neurosurgical Procedures. How We Do It

Operative Neurosurgery ◽

10.1093/ons/opab316 ◽

2021 ◽

Author(s):

Giuseppe Roberto Giammalva ◽

Sofia Musso ◽

Giuseppe Salvaggio ◽

Maria Angela Pino ◽

Rosa Maria Gerardi ◽

...

Keyword(s):

Intraoperative Ultrasound ◽

Extent Of Resection ◽

Operating Rooms ◽

Optical Tracking ◽

Neurosurgical Procedures ◽

Total Resection ◽

Neuronavigation System ◽

Ultrasound System ◽

Almost All ◽

Navigated Ultrasound

Abstract BACKGROUND Intraoperative ultrasound (IOUS) is becoming more and more adopted in neurosurgery, since it has been associated to greater extent of resection (EOR) and to gross total resection (GTR) during brain tumor surgery. IOUS main limitations are spatial resolution, width and orientation of the field of view and scan quality, which are operator-dependent. Furthermore, most neurosurgeons are not confident with this technique, which needs a long learning curve in order to identify and interpret anatomic structures. OBJECTIVE To describe an effective procedure to take advantages of both IOUS and neuronavigation in case of lack of a navigated ultrasound system. METHODS We propose a reliable “indirect-navigated” technique which is based on the optical tracking of un-navigated IOUS probe by the use of a multipurpose passive tracker and a proper configuration of common neuronavigation system. RESULTS Navigated IOUS is not available in all neurosurgical operating rooms but ultrasound systems are common tools in many hospital facilities and neuronavigation systems are common in almost all the neurosurgical operating rooms. The proposed indirect-navigated technique shows some paramount advantages: since almost all the neurosurgical operating rooms are provided with a neuronavigation system, the only tool needed is the ultrasonography. Therefore, this procedure is largely accessible and costless, reliable, and may improve the neurosurgeon's ability in ultrasonographic anatomy. CONCLUSION This technique is based on the coplanar and coupled use of both un-navigated IOUS probe and standard optical neuronavigation, in order to allow the intraoperative navigation of IOUS images when a navigated ultrasound system is not available.

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Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging

Journal of Neurosurgery ◽

10.3171/jns.1996.84.5.0737 ◽

1996 ◽

Vol 84 (5) ◽

pp. 737-741 ◽

Cited By ~ 153

Author(s):

Maarouf A. Hammoud ◽

B. Lee Ligon ◽

Rabih Elsouki ◽

Wei Ming Shi ◽

Donald F. Schomer ◽

...

Keyword(s):

Magnetic Resonance ◽

Mr Imaging ◽

Radiation Effects ◽

Intraoperative Ultrasound ◽

Extent Of Resection ◽

Brain Lesions ◽

Content Type ◽

Recurrent Tumors ◽

A Prospective Study ◽

Fine Print

✓ A prospective study of 70 patients with intraparenchymal brain lesions (36 gliomas and 34 metastases) was performed to evaluate the efficacy of intraoperative ultrasound (IOUS) in localizing and defining the borders of tumors and in assessing the extent of their resection. Eighteen of the 36 glioma patients had no previous therapy. All of these 18 tumors were well localized by IOUS; margins were well defined in 15 and moderately defined in three. The extent of resection was well defined on IOUS in all 18 patients, as confirmed by measurements taken on postoperative magnetic resonance (MR) images (p = 0.90). The remaining 18 patients with gliomas had undergone previous surgery and/or radiation therapy; five had recurrent tumors and 13 had radiation-induced changes. The extent of resection of the recurrent tumors was well defined in all but one patient, as confirmed by postoperative MR imaging. The extent of resection was poorly defined in all 13 patients whose pathology showed radiation effects. All 34 metastatic lesions were well localized and had well-defined margins. In addition, IOUS accurately determined the extent of resection in all cases; the results were confirmed with postoperative MR imaging. In conclusion, IOUS is not only helpful in localizing and defining the margins of gliomas and metastatic brain lesions, it also accurately determines the extent of resection, as confirmed by postoperative MR imaging. This assessment does not apply, however, when the lesion is due primarily to radiation effect.

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Evaluation of Surgical Resection Goal and Its Relationship to Extent of Resection and Patient Outcomes in a Multicenter Prospective Study of Patients With Surgically Treated, Nonfunctioning Pituitary Adenomas: A Case Series

Operative Neurosurgery ◽

10.1093/ons/opz085 ◽

2019 ◽

Vol 18 (1) ◽

pp. 26-33

Author(s):

Andrew S Little ◽

Michael R Chicoine ◽

Daniel F Kelly ◽

Christina E Sarris ◽

Michael A Mooney ◽

...

Keyword(s):

Patient Outcomes ◽

Predictive Value ◽

Pituitary Adenomas ◽

Tumor Resection ◽

Case Series ◽

Residual Tumor ◽

Pituitary Surgery ◽

Extent Of Resection ◽

Subtotal Resection ◽

Nonfunctioning Pituitary Adenomas

Abstract BACKGROUND The influence of the surgeon's preoperative goal regarding the extent of tumor resection on patient outcomes has not been carefully studied among patients with nonfunctioning pituitary adenomas. OBJECTIVE To analyze the relationship between surgical tumor removal goal and patient outcomes in a prospective multicenter study. METHODS Centrally adjudicated extent of tumor resection (gross total resection [GTR] and subtotal resection [STR]) data were analyzed using standard univariate and multivariable analyses. RESULTS GTR was accomplished in 148 of 171 (86.5%) patients with planned GTR and 32 of 50 (64.0%) patients with planned STR (P = .001). Sensitivity, specificity, positive predictive value, and negative predictive value of GTR goal were 82.2, 43.9, 86.5, and 36.0%, respectively. Knosp grade 0-2, first surgery, and being an experienced surgeon were associated with surgeons choosing GTR as the goal (P < .01). There was no association between surgical goal and presence of pituitary deficiency at 6 mo (P = .31). Tumor Knosp grade (P = .004) and size (P = .001) were stronger predictors of GTR than was surgical goal (P = .014). The most common site of residual tumor was the cavernous sinus (29 of 41 patients; 70.1%). CONCLUSION This is the first pituitary surgery study to examine surgical goal regarding extent of tumor resection and associated patient outcomes. Surgical goal is a poor predictor of actual tumor resection. A more aggressive surgical goal does not correlate with pituitary gland dysfunction. A better understanding of the ability of surgeons to meet their expectations and of the factors associated with surgical result should improve prognostication and preoperative counseling.

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