Volumetrische Analyse des Einflusses der intraoperativen Magnetresonanztomographie auf die transsphenoidale Resektion von Hypophysenadenomen

Abstract

Introduction: From 10/2008 to 5/2012, we examined 68 patients who underwent transnasal/transsphenoidal pituitary adenoma surgery in the BKH Günzburg (Neurosurgical Clinic of Ulm University). The average follow-up-time of each patient was 14,2 months. The focus lay on the question whether or not - and to which extent - the application of intraoperative magnetic resonance imaging combined with multimodal neuronavigation could lead to better resection results and a better clinical outcome for the patients. Hereby we notably distinguished between patients who had transsphenoidal surgery before and patients who underwent this kind of surgery for the first time, to see if possible scar tissue from previous operations would play a limiting role for total resection. Methods: In addition to the evaluation of the clinical data we performed a volumetric analysis with the iPlan®-software where we measured the pituitary adenoma in each patient with the preoperatively, intraoperatively and postoperatively acquired MR images. Results: In a total of 70 operations the goal of total tumor resection was achieved in 43 cases (64,2%). 37 patients underwent a second look because the surgeon detected residual adenoma in intraoperative imaging. In 19/68 patients, the iMR lead to further resection and was therefore completed (27,9%). Gross total tumor resection rate thus was increased from initially 38,2% to 66,2%. There was seen no significant difference between patients with previous transnasal/transsphenoidal surgery and patients with primary surgery. 23 patients could not be completed due to suprasellar/parasellar tumor invasion, 10 patients suffered from relapses over time.