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10 years of experience in intraoperative MRI in pituitary surgery
EANS Academy. Pala A. 09/26/19; 276041; EP04059
Andrej Pala
Andrej Pala

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Abstract
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Introduction: Gross total resection (GTR) is the primary goal of pituitary adenoma surgery. Intraoperative MRI (iMRI) may help to achieve this goal and increase extent of resection (EoR), when GTR is not feasible. We have evaluated the influence of iMRI on resection of pituitary adenomas during the past 10 years at our department.
Methods: Retrospective single center analysis of patients treated between 2008 and 2018 for pituitary adenoma by transsphenoidal approach with iMRI. Out of 495 transsphenoidal procedures, 300 consecutive resections of pituitary adenoma with iMRI in 294 patients were identified. The surgery was performed by microscopic, endoscopic or endoscopic assisted microscopic technique. Volumetric EoR in the iMRI and postoperative MRI was calculated. Demographic data, clinical symptoms, endocrine outcome as well as complications were evaluated. Univariate and multivariate cox regression analysis of progression free survival (PFS) was performed.
Results: Continued resection after iMRI performed in 37% (N=111) lead to significantly increased rate of GTR from 54.0% to 66.7% (p< 0.001) and EoR from 86,1% to 94,3% (p< 0.001). GTR was confirmed as the only independent predictor for PFS (p< 0.001) in multivariable Cox regression analysis controlled by age, sex, tumor volume, Knosp grade, subtype of adenoma and recurrence. Improvement of vision was documented in 78.6% of affected patients (N=114/145). New hypopituitarism occurred in 22.0%. Complications requiring revision surgery were observed in 7.3% (N=22).
Conclusion: Our large retrospective analysis suggests a significant influence of iMRI on EoR and GTR in transsphenoidal pituitary surgery independent of Knosp grade or surgical technique employed. As our regression analysis shows, GTR was the only independent predictor of PFS. Every technique available which leads to an increase in GTR thus constitutes a clinically important benefit for our patients.
Introduction: Gross total resection (GTR) is the primary goal of pituitary adenoma surgery. Intraoperative MRI (iMRI) may help to achieve this goal and increase extent of resection (EoR), when GTR is not feasible. We have evaluated the influence of iMRI on resection of pituitary adenomas during the past 10 years at our department.
Methods: Retrospective single center analysis of patients treated between 2008 and 2018 for pituitary adenoma by transsphenoidal approach with iMRI. Out of 495 transsphenoidal procedures, 300 consecutive resections of pituitary adenoma with iMRI in 294 patients were identified. The surgery was performed by microscopic, endoscopic or endoscopic assisted microscopic technique. Volumetric EoR in the iMRI and postoperative MRI was calculated. Demographic data, clinical symptoms, endocrine outcome as well as complications were evaluated. Univariate and multivariate cox regression analysis of progression free survival (PFS) was performed.
Results: Continued resection after iMRI performed in 37% (N=111) lead to significantly increased rate of GTR from 54.0% to 66.7% (p< 0.001) and EoR from 86,1% to 94,3% (p< 0.001). GTR was confirmed as the only independent predictor for PFS (p< 0.001) in multivariable Cox regression analysis controlled by age, sex, tumor volume, Knosp grade, subtype of adenoma and recurrence. Improvement of vision was documented in 78.6% of affected patients (N=114/145). New hypopituitarism occurred in 22.0%. Complications requiring revision surgery were observed in 7.3% (N=22).
Conclusion: Our large retrospective analysis suggests a significant influence of iMRI on EoR and GTR in transsphenoidal pituitary surgery independent of Knosp grade or surgical technique employed. As our regression analysis shows, GTR was the only independent predictor of PFS. Every technique available which leads to an increase in GTR thus constitutes a clinically important benefit for our patients.
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