Document Detail


Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging.
MedLine Citation:
PMID:  16479628     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The two most recent significant advances in pituitary surgery have been the endonasal endoscopic approach and intraoperative magnetic resonance imaging (IMRI). Each provides improved visualization of intra- and parasellar anatomy with the goal of attaining a complete resection. The combination of the two techniques has not been previously reported in the literature. METHODS: We performed endoscopic, endonasal resection of pituitary macroadenomas in 15 patients using the Polestar N-10 (0.12T) IMRI (Odin Medical Technologies, Inc., Newton, MA). Eleven patients had nonfunctioning tumors, three had acromegaly, and one had a medication-resistant prolactinoma. The effect of the magnetic field on the cathode ray tube screen and the image quality of the IMRI images were assessed. The presence of residual tumor on IMRI was noted and then re-examined with the endoscope. RESULTS: Although the Polestar N-10 is a low Tesla magnet, the IMRI caused significant distortion of the cathode ray tube screen regardless of the viewing angle. This was overcome with the use of a wall-mounted plasma screen. IMRI images were obtained in all cases and were of sufficiently high quality to demonstrate adequate decompression of the optic chiasm and the removal of all suprasellar tumor. In three cases, residual tumor was found with IMRI that was resected endoscopically before the completion of surgery. In four other cases, potential residual tumor was examined endoscopically and found to be normal postoperative change. In eight cases no residual intrasellar tumor was seen on the IMRI. Preresection visual deficits improved in all cases and the insulin-like growth factor levels normalized in two of three cases. There were no delayed cerebrospinal fluid leaks. CONCLUSION: Combining intraoperative endoscopy and IMRI is feasible and distortion of the cathode ray tube screen can be overcome with the use of either a plasma or liquid crystal display screen. Each technology provides complementary information, which can assist the surgeon in safely maximizing the extent of resection. In this small series using a low-field magnet, rates of residual tumor following endoscopic transsphenoidal surgery were less than have been reported following microscope-based transsphenoidal surgery.
Authors:
Theodore H Schwartz; Phillip E Stieg; Vijay K Anand
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  58     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2006 Feb 
Date Detail:
Created Date:  2006-02-14     Completed Date:  2006-05-31     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  ONS44-51; discussion ONS44-51     Citation Subset:  IM    
Affiliation:
Department of Neurological Surgery, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York 10021, USA. schwarh@med.cornell.edu
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MeSH Terms
Descriptor/Qualifier:
Adenoma / pathology,  surgery*
Adult
Aged
Endoscopy / methods*
Female
Humans
Hypophysectomy / methods*
Image Processing, Computer-Assisted / methods
Magnetic Resonance Imaging / methods
Male
Middle Aged
Monitoring, Intraoperative / instrumentation*
Neuronavigation / methods
Operating Rooms
Pituitary Gland / pathology,  surgery
Pituitary Neoplasms / pathology,  surgery*
Sphenoid Sinus / pathology,  surgery*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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