Intraoperative Magnetic Resonance Imaging During Endoscopic Transsphenoidal Surgery of Growth Hormone-Secreting Pituitary Adenomas

• Published in: World neurosurgery Vol. 91; pp. 490 - 496
• Main Authors: Netuka, David, Májovský, Martin, Masopust, Václav, Belšán, Tomáš, Marek, Josef, Kršek, Michal, Hána, Václav, Ježková, Jana, Beneš, Vladimír
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2016
• Subjects: Acromegaly; Adenoma - surgery; Adolescent; Adult; Aged; Child; Female; Growth hormone; Growth Hormone-Secreting Pituitary Adenoma - surgery; Humans; Intraoperative Care - methods; Intraoperative MRI; Magnetic Resonance Imaging; Male; Middle Aged; Neuroendoscopy - methods; Pituitary adenoma; Postoperative Complications - etiology; Remission Induction - methods; Transsphenoidal surgery; Young Adult; GH; IGF-I; Transsphenoidal surgery; MRI; Pituitary adenoma; Acromegaly; Intraoperative MRI; iMRI; Growth hormone; OGTT
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.04.094

The effect of intraoperative magnetic resonance imaging (iMRI) on the extent of sellar region tumors treated endonasally has been described in previous research. However, the effects of iMRI on endocrinologic outcome of growth hormone-secreting adenomas have been studied in only a few small cohort studies. Inclusion criteria were primary transsphenoidal surgery for growth hormone-secreting adenoma from January 2009 to December 2014, a minimum follow-up of 1 year, complete endocrinologic data, at least 1 iMRI, and at least 2 postoperative magnetic resonance images. The cohort consisted of 105 patients (54 females, 51 males) with a mean age of 48.3 years (range, 7–77 years). There were 16 microadenomas and 89 macroadenomas. Endocrinologic remission in the whole cohort was achieved in 64 of the patients (60.9%). Resection after iMRI was attempted in 22 of the cases (20.9%). Resection after iMRI led to hormonal remission in 9 cases (8.6%). Endocrinologic postoperative deficit was observed in 10 cases (12.5%). Postoperative cerebrospinal fluid leakage indicated the necessity to reoperate in 3 cases (3.8%). No neurologic deterioration was observed. iMRI influences not only the morphologic extent of pituitary adenomas resection but also the endocrinologic results. We encourage the routine application of iMRI in pituitary adenoma surgery, including hormone-secreting pituitary tumors.