Intraoperative low field MRI in transsphenoidal pituitary surgery

Background Intraoperative low field MRI (iMRI, 0.15 T) during transsphenoidal surgery on pituitary adenomas (PAs) may significantly improve tumor removal. However, extensive surgery can lead to pituitary hormone deficiency. Furthermore, introduction of iMRI will prolong duration of surgery, which may elevate risk of postoperative infections. Methods Overall, 180 transsphenoidal surgeries for PAs from 2007 to 2015 were included. IMRI was available from 2011 to 2015, during this period 67/78 (86%) surgeries were with iMRI (iMRI, n = 67). A total of 113 surgeries were performed without iMRI (controls). All surgical procedures were performed by microscopic technique. Tumor size, hormonal status and vision were assessed before surgery and 3–5 months postoperatively. Results Gross total resection (GTR), mean tumor remnant volume and ∆-volumes were comparable between iMRI and controls: 15% (10/66) vs 23% (26/109) (P = 0.17), 2.97 cm3 (0.9–5) vs 2.1 cm3 (1.6–2.6) (P = 0.3) and 4.5 cm3 (3.6–5.5) vs 5.1 cm3 (4.2–6) (P = 0.4), respectively. Duration of surgery was significantly longer during iMRI vs controls: 126 min (117–135) vs 98 min (92–103) (P < 0.001). New pituitary–adrenal deficiency in iMRI vs controls was seen in 35% (17/48) and 35% (23/66) of surgeries, respectively (P = 0.95). New thyroid deficiency was found in 33% (13/29) and 41% (28/69) and visual field deficiencies improved in 44% (19/43) and 38% (23/60) in iMRI vs controls, respectively (P > 0.1). Conclusion Tumor remnant after pituitary surgery was not significantly reduced using intraoperative low field MRI. Duration of surgery was increased in iMRI, but was not associated with increased infection rate. Pituitary hormonal function and vision were comparable between iMRI and controls.

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Endoscopic vs. microscopic transsphenoidal pituitary surgery: a single centre study

Scientific Reports ◽

10.1038/s41598-020-78823-z ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Morten Winkler Møller ◽

Marianne Skovsager Andersen ◽

Dorte Glintborg ◽

Christian Bonde Pedersen ◽

Bo Halle ◽

...

Keyword(s):

Visual Impairment ◽

Tumour Size ◽

Pituitary Surgery ◽

Endoscopic Technique ◽

Electronic Patient Records ◽

Beneficial Effects ◽

Duration Of Surgery ◽

Single Centre Study ◽

Transsphenoidal Pituitary Surgery ◽

Endoscopic Group

AbstractEndoscopic pituitary surgery has shown promising results. This study reports the experiences of experienced microscopic pituitary surgeons changing to the endoscopic technique, and the beneficial effects on the postoperative outcomes. 45 transsphenoidal endoscopic-assisted surgeries performed in 2016–2017 were compared with 195 microscope-assisted surgeries performed in 2007–2017 for pituitary adenoma. Tumour size, hormonal status and vision were assessed preoperatively and 3–5 months postoperatively. Cases were identified through electronic patient records. GTR was achieved in 39% of the endoscopic operations vs. 22% of microscopic operations, p = 0.018. Mean duration of surgery was 86 min (77–95) with the endoscopic technique vs. 106 min (101–111) with the microscopic technique, p < 0.001. New hypothalamus–pituitary–adrenal axis deficiencies were observed after 3% of endoscopic vs. 34% microscopic operations, p = 0.001, and overall fewer postoperative pituitary deficiencies were observed in the endoscope-assisted group. Complications within 30 days of surgery occurred in 17% of endoscopic operations vs. 27% of microscopic operations (p > 0.05). Normalization of visual impairment occurred in 37% of the cases with preoperative visual impairment in the endoscopic group vs. 35% of those in the microscopic group (p > 0.05). The endoscopic technique performed better as a surgical procedure for pituitary adenomas. We found no statistically significant differences in complication rate or visual improvement between the two techniques.

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4K 3-dimensional video microscope system (orbeye) for transsphenoidal pituitary surgery

Acta Neurochirurgica ◽

10.1007/s00701-021-04762-x ◽

2021 ◽

Author(s):

Roman Rotermund ◽

Jan Regelsberger ◽

Katharina Osterhage ◽

Jens Aberle ◽

Jörg Flitsch

Keyword(s):

3D Visualization ◽

Remission Rate ◽

Subjective Evaluation ◽

Pituitary Surgery ◽

Image Resolution ◽

Wide Range ◽

Significant Difference ◽

Duration Of Surgery ◽

Video Microscope ◽

Transsphenoidal Pituitary Surgery

Abstract Background In previous reports on experiences with an exoscope, this new technology was not found to be applicable for transsphenoidal pituitary surgery. As a specialized center for pituitary surgery, we were using a 4K 3D video microscope (Orbeye, Olympus) to evaluate the system for its use in transsphenoidal pituitary surgery in comparison to conventional microscopy. Method We report on 296 cases performed with the Orbeye at a single institution. An observational study was conducted with standardized subjective evaluation by the surgeons after each procedure. An objective measurement was added to compare the exoscopic and microscopic methods, involving surgery time and the initial postoperative remission rate in matched cohorts. Results The patients presented with a wide range of pathologies. No serious events or minor complications occurred based on the usage of the 4K 3D exoscope. There was no need for switching back to the microscope in any of the cases. Compared to our microsurgically operated collective, there was no significant difference regarding duration of surgery, complications, or extent of resection. The surgeons rated the Orbeye beneficial in regard to instrument size, positioning, surgeon’s ergonomics, learning curve, image resolution, and high magnification. Conclusions The Orbeye exoscope presents with optical and digital zoom options as well as a 4K image resolution and 3D visualization resulting in better depth perception and flexibility in comparison to the microscope. Split screen mode offers the complementary benefit of the endoscope which may increase the possibilities of lateral view but has to be evaluated in comparison to endoscopic transsphenoidal procedures in the next step.

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Open Low-Field Intraoperative MRI for Transsphenoidal Pituitary Surgery

Anesthesia & Analgesia ◽

10.1213/01.ane.0000268558.02855.73 ◽

2007 ◽

Vol 105 (3) ◽

pp. 886 ◽

Cited By ~ 6

Author(s):

Pierre Pandin ◽

Olivier Dewitte

Keyword(s):

Pituitary Surgery ◽

Intraoperative Mri ◽

Low Field ◽

Transsphenoidal Pituitary Surgery

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Hypogonadism: Is It Always Hypogonadotropic in an Adolescent With a Cleft Palate? A Surprising Case of Klinefelter Syndrome

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620967601 ◽

2020 ◽

pp. 105566562096760

Author(s):

Bahar Özcabı ◽

Meriç Vatansever ◽

Ayla Güven

Keyword(s):

Mental Retardation ◽

Cleft Palate ◽

Klinefelter Syndrome ◽

Wide Spectrum ◽

Hormone Deficiency ◽

Pituitary Hormone ◽

First Case ◽

Midline Defects ◽

Adrenal Deficiency ◽

Testicular Size

Pituitary hormone deficiencies may occur in children with midline defects; in these cases, hypogonadism is usually hypogonadotropic. Herein, we report a boy at the age of 13.8 years with mild mental retardation, previously operated for complete cleft palate (isolated) and presented with hypoglycemia due to isolated secondary adrenal insufficiency, who further had a decrease in testicular size with increased follicle-stimulating hormone level (hypergonadotropic hypogonadism) and diagnosed with Klinefelter syndrome. Klinefelter syndrome in childhood is rarely diagnosed and cases are observed in a wide spectrum. Although some regional duplications of the X chromosome also show midline defects such as spina bifida-neural tube defects, mental retardation, hypopituitarism (mostly growth hormone deficiency); coexistence of Klinefelter syndrome and isolated secondary adrenal deficiency/midline defect in our case may also be coincidental. However, to our knowledge, this is the first case in literature with this association in a patient with a 47, XXY karyotype.

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Preliminary Experience with Intraoperative Low-Field MRI in Pituitary Surgery

Skull Base ◽

10.1055/s-2005-916505 ◽

2005 ◽

Vol 15 (S 2) ◽

Author(s):

Rüdiger Gerlach ◽

R. Krishnan ◽

V. Ntoukas ◽

G. Marquardt ◽

A. Raabe ◽

...

Keyword(s):

Pituitary Surgery ◽

Low Field ◽

Low Field Mri

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159 Factors Associated with Postoperative Complications Following Transsphenoidal Surgery for Pituitary Tumor resection from the national Surgical Quality Improvement Program (NSQIP)

Neurosurgery ◽

10.1093/neuros/nyx417.159 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 239-240

Author(s):

Andrew Karl Rock ◽

Charles Frederick Opalak ◽

Kathryn Workman ◽

Matthew Carr ◽

William C Broaddus

Keyword(s):

Postoperative Complications ◽

Transsphenoidal Surgery ◽

Tumor Resection ◽

Pituitary Tumors ◽

Pituitary Surgery ◽

Improvement Program ◽

Surgical Quality ◽

Duration Of Surgery ◽

Transsphenoidal Pituitary Surgery ◽

Complications And Mortality

Abstract INTRODUCTION Pituitary tumors are the second most common brain tumor (15.9%) in the United States. Transsphenoidal surgery is commonly indicated for pituitary tumors and few studies have investigated postoperative complications following this procedure. Our objective was to utilize the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) to estimate the prevalence of and risk factors for complications following transsphenoidal pituitary surgery. METHODS Patients undergoing transsphenoidal surgery for pituitary tumor resection (CPT codes: 61 548, 62 165) from 2005 to 2015 were extracted from the ACS-NSQIP. The prevalence of postoperative complications was determined. Multivariable logistic regression was used to identify demographic, comorbid, and perioperative characteristics associated with any morbidity, severe (Clavien IV) complications, and mortality. RESULTS >Within 1177 transsphenoidal surgeries, there were 105 (8.92%) cases with at least one non-fatal complication, 29 (2.46%) cases with a severe complication, and 11 (0.93%) cases of mortality. The three most common complications were: reoperation (3.40%), transfusion (2.04%), and unplanned intubation (2.70%). In multivariable logistic regression analysis, the only significant predictors for postoperative complications were: 1) duration of surgery in hours for any morbidity (Odds Ratio [OR]: 1.30; 95% Confidence Interval [CI]: 1.15-1.46; P < 0.001), severe complications (OR: 1.38; 95% CI; 1.18-1.61; P < 0.001), and mortality (OR: 1.36; 95% CI: 1.11-1.67; P < 0.01); and 2) American Society of Anesthesiologists (ASA) class III-V for any morbidity (OR: 1.99; 95% CI: 1.23-3.21; P < 0.05) and severe complications (OR: 2.99; 95% CI: 1.13-7.94; P < 0.05). The area under the curve for any morbidity, severe complications, and mortality were 0.67, 0.74, and 0.77, respectively. CONCLUSION Transsphenoidal pituitary surgery is a relatively safe procedure with any morbidity occurring in approximately 1 in 10 patients and mortality occurring in approximately 1 in 100 patients. Our findings demonstrate duration of surgery and higher ASA classification is associated with increased risk for postoperative complications following transsphenoidal pituitary surgery.

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