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Article

The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas

1
Department of Neurosurgery, University of Ulm, Lindenallee 2, 89312 Günzburg, Germany
2
Department of Neurosurgery, University of Ulm, Alber-Einsteint-Allee 23, 89081 Ulm, Germany
3
Department of Endokrinology, Endokrinologiezentrum Ulm, Bahnhofplatz 7, 89073 Ulm, Germany
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2022, 29(1), 392-401; https://doi.org/10.3390/curroncol29010035
Received: 13 December 2021 / Revised: 9 January 2022 / Accepted: 13 January 2022 / Published: 17 January 2022
(This article belongs to the Special Issue Recent Advancements in the Surgical Treatment of Brain Tumors)
The surgical treatment of recurrent adenomas can be challenging. Intraoperative magnetic resonance imaging (iMRI) can improve the orientation and increase the safe extent of resection. We conducted a quantitative and qualitative retrospective analysis of recurrent adenomas treated by endoscopic or microscopic iMRI-assisted transsphenoidal surgery. A total number of 59 resections were selected. Detailed volumetric measurements, tumor characteristics, and MRI features of intraoperative remnants were evaluated. Intraoperative MRI increased the gross total resection (GTR) rate from 33.9% to 49.2%. Common locations of tumor remnants after iMRI were the clivus, the wall of the cavernous sinus or the perforation of the diaphragm. Increasing tumor volume and the microscopic technique were significantly associated with further resection after iMRI in the univariate analysis (p = 0.004, OR 1.6; p = 0.009, OR 4.4). Only the increasing tumor volume was an independent predictor for further resection (p = 0.007, OR 1.5). A significantly higher proportion of GTRs was achieved with the endoscopic technique (p = 0.001). Patients with a large recurrent pituitary adenoma who underwent microscopic transsphenoidal resection were the most likely to benefit from iMRI regarding the extent of resection. Occult invasions of the cavernous sinus and/or the clivus were the most common findings leading to further resection of tumor remnants after iMRI. View Full-Text
Keywords: transsphenoidal surgery; intraoperative MRI; pituitary adenoma; intraoperative tumor remnant; complications transsphenoidal surgery; intraoperative MRI; pituitary adenoma; intraoperative tumor remnant; complications
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MDPI and ACS Style

Pala, A.; Knoll, A.; Schneider, M.; Etzrodt-Walter, G.; Karpel-Massler, G.; Wirtz, C.R.; Hlavac, M. The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas. Curr. Oncol. 2022, 29, 392-401. https://doi.org/10.3390/curroncol29010035

AMA Style

Pala A, Knoll A, Schneider M, Etzrodt-Walter G, Karpel-Massler G, Wirtz CR, Hlavac M. The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas. Current Oncology. 2022; 29(1):392-401. https://doi.org/10.3390/curroncol29010035

Chicago/Turabian Style

Pala, Andrej, Andreas Knoll, Max Schneider, Gwendolin Etzrodt-Walter, Georg Karpel-Massler, Christian R. Wirtz, and Michal Hlavac. 2022. "The Benefit of Intraoperative Magnetic Resonance Imaging in Endoscopic and Microscopic Transsphenoidal Resection of Recurrent Pituitary Adenomas" Current Oncology 29, no. 1: 392-401. https://doi.org/10.3390/curroncol29010035

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