The Value of Intraoperative Magnetic Resonance Imaging in Endoscopic Endonasal Resection of Pituitary Adenoma

Abstract

Background Intraoperative magnetic resonance images (iMRIs) have been variably adopted by some centers to help increase the rate of gross total resection (GTR) of pituitary adenomas. In this comparative study, we report our institution's experience with using iMRIs for endoscopic endonasal approach (EEA) pituitary adenoma resection to better elucidate its role and potential value for pituitary surgery.

Methods All adult patients who underwent EEA for a pituitary adenoma from January 2013 to September 2021 were retrospectively reviewed. GTR was defined as no residual tumor or recurrence on postoperative imaging within 6 months. Univariate analysis followed by multivariate analysis was performed with GTR as the categorical endpoint. To measure the independent effect of iMRI on GTR, propensity score matching was then performed.

Results A total of 351 pituitary adenoma patients who underwent EEA were identified. The mean age was 51.2 (range: 18–90) years and 196 (55.8%) patients were female. iMRI was utilized in 87 (24.8%) cases. The overall rate of GTR was 69.2%. On multivariate analysis, low Knosp grade, low tumor volume, and the use of iMRI were predictive of GTR. There was no difference in the need for desmopressin or hydrocortisone at 90 days postoperatively.

Conclusion At our institution, we report a significant absolute increase in GTR rates of 16.4% for patients undergoing an iMRI. Among iMRI patients who did not have GTR, the majority of residuals were intentionally left behind after being deemed too risky to pursue. Overall, this study suggests the high value that iMRI adds to endoscopic pituitary adenoma surgery.

Keywords

intraoperative MRI - endoscopic endonasal approach - pituitary adenoma - cavernous sinus - suprasellar cistern

Publikationsverlauf

Eingereicht: 19. Mai 2022

Angenommen: 03. August 2022

Accepted Manuscript online:
16. August 2022

Artikel online veröffentlicht:
28. September 2022

• References

• 1 Molitch ME. Chapter 12 - Nonfunctioning pituitary tumors. In: Fliers E, Korbonits M, Romijn JA. eds. Handbook of Clinical Neurology. Vol. 124. Amsterdam, the Netherlands: Elsevier; 2014: 167-184
• 2 Almeida JP, de Andrade E, Reghin-Neto M, Radovanovic I, Recinos PF, Kshettry VR. From above and below: the microsurgical anatomy of endoscopic endonasal and transcranial microsurgical approaches to the parasellar region. World Neurosurg 2022; 159: e139-e160
• 3 Pala A, Knoll A, Schneider M. et al. The benefit of intraoperative magnetic resonance imaging in endoscopic and microscopic transsphenoidal resection of recurrent pituitary adenomas. Curr Oncol 2022; 29 (01) 392-401
• 4 Ogiwara T, Hori T, Fujii Y. et al. Effectiveness of the intraoperative magnetic resonance imaging during endoscopic endonasal approach for acromegaly. Pituitary 2021; 24 (05) 690-697
• 5 Tanji M, Kataoka H, Kikuchi M. et al. Impact of intraoperative 3-Tesla MRI on endonasal endoscopic pituitary adenoma resection and a proposed new scoring system for predicting the utility of intraoperative MRI. Neurol Med Chir (Tokyo) 2020; 60 (11) 553-562
• 6 Strange F, Remonda L, Schütz P, Fandino J, Berkmann S. 10 years' experience of using low-field intraoperative MRI in transsphenoidal surgery for pituitary adenoma: results of the Swiss Pituitary Registry (SwissPit). World Neurosurg 2020; 136: e284-e293
• 7 Staartjes VE, Togni-Pogliorini A, Stumpo V, Serra C, Regli L. Impact of intraoperative magnetic resonance imaging on gross total resection, extent of resection, and residual tumor volume in pituitary surgery: systematic review and meta-analysis. Pituitary 2021; 24 (04) 644-656
• 8 Gerlach R, du Mesnil de Rochemont R, Gasser T. et al. Feasibility of Polestar N20, an ultra-low-field intraoperative magnetic resonance imaging system in resection control of pituitary macroadenomas: lessons learned from the first 40 cases. Neurosurgery 2008; 63 (02) 272-284 , discussion 284–285
• 9 Heck A, Ringstad G, Fougner SL. et al. Intensity of pituitary adenoma on T2-weighted magnetic resonance imaging predicts the response to octreotide treatment in newly diagnosed acromegaly. Clin Endocrinol (Oxf) 2012; 77 (01) 72-78
• 10 Chen W, Wang M, Duan C. et al. Prediction of the recurrence of non-functioning pituitary adenomas using preoperative supra-intra sellar volume and tumor-carotid distance. Front Endocrinol (Lausanne) 2021; 12: 748997
• 11 Cohen-Cohen S, Gardner PA, Alves-Belo JT. et al. The medial wall of the cavernous sinus. Part 2: selective medial wall resection in 50 pituitary adenoma patients. J Neurosurg 2018; 131 (01) 131-140
• 12 Parasher AK, Lerner DK, Glicksman JT. et al. Drivers of in-hospital costs following endoscopic transphenoidal pituitary surgery. Laryngoscope 2021; 131 (04) 760-764
• 13 Chua MMJ, Lewis K, Huang Y-A, Fingliss M, Farber A. A successful organized effort to improve operating room first-case starts in a tertiary academic medical center. Am Surg 2021; 87 (02) 259-265