[Pituitary adenomas: neurosurgical treatment].
Universitätsklinik für Neurochirurgie, Universität Wien, Wien, Osterreich.Wiener klinische Wochenschrift (Impact Factor: 0.84). 02/2003; 115 Suppl 2(2):28-32.
Due to their diversity, pituitary adenomas represent an interdisciplinary therapeutic challenge in regard to endocrinology, radiology and neurosurgery. Advanced radiological methods such as magnetic resonance imaging (MRI) and the possibility of three-dimensional reconstruction have profoundly improved surgical planning and intraoperative neuronavigation. With the application of modern surgical techniques like endoscope-assisted microsurgery or pure endoscopic surgery further improvements in the treatment of pituitary adenomas at difficult locations can be expected. Major prognostic factors predicting surgical outcome are extension of the adenoma and invasivity into adjacent structures. Both may be perfectly visualized by high-resolution MRI. The proliferation marker MIB-1 as a parameter of growth-rate and invasivity of pituitary adenomas provides information for postoperative management in terms of additional treatment and follow-up imaging. The current management of pituitary adenomas is discussed according to the different therapeutic options available and new developments are presented.
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ABSTRACT: The treatment of choice in Cushing's disease (CD) is surgical removal; however, most tumors are too small to be detected. The objective was to establish a method to achieve the complete removal of tumors on the basis of the results of high-resolution magnetic resonance imaging (MRI), inferior petrosal sinus sampling (IPSS), and a surgical resection technique using frozen biopsy. Eighteen patients who underwent transsphenoidal surgery from 2004 to 2010 were included. High-resolution MRI and IPSS, multiple-staged resection, and tumor tissue identification in frozen sections (surgical and histological identification, SHI) were performed. All patients achieved surgical remission, as confirmed by 24 h urinary free cortisol excretion tests. Visible microlesions were identified on the initial MRI in 11 patients (61%). The SHI findings agreed with the MRI findings in 10 of the 11 patients (90.9%) and with IPSS lateralization in 6 of the 11 patients (54.5%). In the 7 patients whose lesions were not visible on the initial MRI, only 1 (14.3%) showed an agreement between IPSS and SHI. In 3 of the 7 patients, the microlesions were identified by additional MRI. The rate of concordance with SHI was 77.8% for the overall MRI and 38.9% for IPSS. High-resolution MRI is better than IPSS for localizing corticotroph adenomas. In patients with lesions not visible on the initial MRI, additional MRI should be performed using a different protocol. Although high-resolution MRI is better for localizing tumors, SHI remains an important approach for removing the tumors completely.Endocrine 06/2011; 40(3):452-61. DOI:10.1007/s12020-011-9499-5 · 3.88 Impact Factor
Article: Advanced Cranial Navigation[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND: Cranial surgical navigation is most commonly performed by registration with fiducial markers, optic tracking, and intermittent pointer-based application. OBJECTIVE: To assess the accuracy and applicability of an advanced cranial navigation setup. METHODS: Continuous electromagnetic instrument navigation was used in 136 neurosurgical cases with a standard navigation system. A phantom head in an intraoperative magnetic resonance imaging environment was used to compare the accuracy of the advanced and standard navigation setups. RESULTS: A navigated suction device was used in 71 cases of intracranial tumor surgery and 46 cases of endoscopic transsphenoidal surgery. The ventriculoscope was navigated in 6 cases and the stereotactic biopsy needle in 4 cases. Electromagnetic tracking was used for catheter placement in 9 cases. The learning curve comprised 6 of the 136 cases during the first month of application. No significant difference was observed at the intracranial target points between the standard navigation setup using optic tracking, fiducial marker registration, and pointer and the advanced navigation setup with electromagnetic tracking, surface-based registration, and navigation of a field-detecting stylet in a standard metal suction tube when performed outside the 5-G line of the 3.0-T intraoperative magnetic resonance imaging. CONCLUSION: Continuous instrument navigation is the prerequisite for seamless integration of navigation systems into the neurosurgical operating workflow. Our data confirm that the application of preoperative imaging, surface-merge registration, and continuous electromagnetic tip-tracked instrument navigation may provide such integration without a significant reduction in accuracy compared with standard navigation. ABBREVIATIONS: EM, electromagnetic iMRI, intraoperative magnetic resonance imaging RMSE, root mean square errorNeurosurgery 01/2013; 72:A43-A53. DOI:10.1227/NEU.0b013e3182750c03 · 3.62 Impact Factor
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