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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.

ABSTRACT: The aim of this study was to evaluate the impact of 3-Tesla intraoperative high-field magnetic resonance imaging (3T-iMRI) for pituitary adenoma resection, and to propose a new scoring system for predicting the utility of 3T-iMRI. This retrospective study evaluated 82 patients with pituitary adenoma who underwent purely endoscopic endonasal resection with 3T-iMRI between 2015 and 2019. 3T-iMRI revealed unexpected residual tumor in 39 cases (47.6%), which led to further resection and contributed to upgrading of the resection level in 28 cases (34.1%), which led to gross total resection rates (GTRs) of 67.1% and near total resection of 15.9%. To construct a new scoring system, patients were divided into a discovery cohort (56 patients) and a validation cohort (26 patients). Three variables for the scoring system were selected according to a univariate analysis of the discovery cohort: the size of the tumor (>20 mm: 1 point), the presence of suprasellar tumor lobulation (1 point) and the history of previous operations (1 point). The risk of additional resection after iMRI was well stratified by this scoring system (range 0-3; p = 0.0037 for trend). Robustness of the system was confirmed in the validation cohort (0 points, 0%; 1 point, 30.8%; 2 points, 70.0%; 3 points, 100%; p = 0.0116 for trend). These results indicate that 3T-iMRI optimized the extent of resection, even with the use of an endoscope, and that the proposed scoring system is useful for predicting whether 3T-iMRI is likely to be of value for a particular patient.

SUBMITTER: Tanji M

PROVIDER: S-EPMC7788269 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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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.

Tanji Masahiro M Kataoka Hiroharu H Kikuchi Masahiro M Sakamoto Tatsunori T Kuwata Fumihiko F Matsunaga Mami M Nakagawa Takayuki T Mineharu Yohei Y Arakawa Yoshiki Y Yoshida Kazumichi K Miyamoto Susumu S

Neurologia medico-chirurgica 20201021 11

The aim of this study was to evaluate the impact of 3-Tesla intraoperative high-field magnetic resonance imaging (3T-iMRI) for pituitary adenoma resection, and to propose a new scoring system for predicting the utility of 3T-iMRI. This retrospective study evaluated 82 patients with pituitary adenoma who underwent purely endoscopic endonasal resection with 3T-iMRI between 2015 and 2019. 3T-iMRI revealed unexpected residual tumor in 39 cases (47.6%), which led to further resection and contributed ...[more]

PMID: 33087635

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Project description:Objective: To investigate the factors associated with recurrence/progression after endoscopic endonasal resection of suprasellar craniopharyngiomas. Special attention was paid to assess the impact of pituitary stalk preservation on tumor recurrence/progression and endocrinological outcomes. Methods: We retrospectively recruited 73 patients with suprasellar craniopharyngiomas undergone endoscopic endonasal approach (EEA) surgery from September 2014 to May 2019 and assessed their clinical characteristics, surgical outcomes, and recurrence/progression. Stalk preservation or sacrifice was determined by reviewing operative records, videos, and post-operative magnetic resonance imaging. Results: Gross total resection (GTR) was achieved in 51 cases (69.9%). Tumor recurrence was seen in 5 cases (9.8%) and progression was seen in 8 cases (36.4%), respectively. GTR (OR = 0.248 CI 0.081-0.759; p = 0.015) was the only independent factor influencing recurrence/progression. Kaplan-Meier survival analysis showed that the mean recurrence/progression-free survival were 53 (95% CI 48-59) and 39 (95% CI 28-50) months, respectively, in patients with and without GTR (p = 0.011). Pituitary stalk preservation was more common in cases with peripheral type tumors (83% vs. 30%, p < 0.01). Preserving the pituitary stalk does not appear to decrease the percentage of GTR (75.5% vs. 55.0%, p = 0.089), or increase the rate of tumor recurrence (12.5% vs. 0%, p = 0.508) or progression (46.2% vs. 22.2%, p = 0.486). However, surgically induced hypothyroidism (60.5% vs. 100%, p = 0.041) and diabetes insipidus (35.1% vs. 81.8%, p = 0.017) were significantly lower in patients with stalk preservation. For patients who had hypopituitarism before EEA, there was no difference between those with and without stalk preservation regarding post-operative hypopituitarism (p > 0.05). Conclusion: GTR is the only independent predictor of recurrence/progression after EEA surgery for suprasellar craniopharyngiomas. Preserving the pituitary stalk does not appear to increase the risk of non-GTR and tumor recurrence/progression and might help reduce the risk of surgically induced hypothyroidism and diabetes insipidus. We recommend preserving the pituitary stalk in peripheral type suprasellar craniopharyngiomas with normal pituitary function, especially in cases without hypothyroidism or diabetes insipidus. On the other hand, stalk sacrifice could be considered in central type tumors with severe pre-operative endocrinopathy.

Project description:PurposeThe aim of the present study is to analyze the changes in retinal vessel density (VD), using Optical Coherence Tomography Angiography (OCT-A), in patients that received endoscopic endonasal approach for the removal of an intra-suprasellar pituitary adenoma compressing optic chiasm.MethodsWe evaluated the VD in Superficial Capillary Plexus (SCP), Deep Capillary Plexus (DCP), Radial Peripapillary Capillary (RPC) and the Foveal Avascular Zone (FAZ) area in a series of fourteen patients (7 males, 7 females, mean age 56 ± 13 years), as compared to healthy controls. We also detected the structural Spectral Domain (SD)-OCT parameters: Ganglion Cell Complex (GCC), Retinal Nerve Fiber Layer (RNFL), visual field parameters (Mean Deviation, Pattern Standard Deviation) and Best Corrected Visual Acuity (BCVA). These measurements were performed prior than surgery and 48 hours after.ResultsThe patients showed a significant decrease in VD of the macular and papillary regions, a significant increase in FAZ area, a significant impairment in SD-OCT, VF parameters and BCVA respect to 14 eyes of 14 healthy controls (p<0.05), at pre-op evaluation. In patients group the VD in SCP, DCP and RPC increased after surgery respect to baseline but the difference turned to be out statistically significant only in RPC (p = 0.003). Also the BCVA (p = 0.040) and the Mean Deviation at visual field (p = 0.015) significantly improved after surgery. While there was a reduction in structural OCT parameters but it was statistically significant only in GCC (p = 0.039). A positive correlation was found between the preoperative VD of the RPC, Mean Deviation, BCVA and the postoperative Mean Deviation (r = 0.426 p = 0.027; r = 0.624 p = 0.001; r = 0.515 p = 0.006).ConclusionOCT-A allows to detect the early changes occurring within 48 hours after surgery showing that the improvement in retinal vessel density could occur before the recovery of the structural OCT parameters and can be a positive predictive factor for the functional recovery.

Dataset Information

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.

Publications

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.

Similar Datasets

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