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Effectiveness of the intraoperative magnetic resonance imaging during endoscopic endonasal approach for acromegaly

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Abstract

Purpose

Acromegaly is an acquired disorder usually caused by growth hormone-secreting pituitary adenoma, resolution of which requires correction of the excess hormone production. Recently, intraoperative magnetic resonance imaging (iMRI) was reported to be useful during the endoscopic endonasal approach (EEA) for pituitary adenoma. The present study was performed to quantitatively assess the role of iMRI in improving surgical outcomes in EEA for acromegaly.

Methods

Twenty surgeries for acromegaly in EEA performed at Shinshu University Hospital between April 2016 and March 2020 were reviewed retrospectively. The inclusion criteria were cases without severe cavernous sinus tumor invasion (Knosp grade 0 – 3) or history of prior pituitary surgery. Fifteen consecutive patients were enrolled in this study. Clinical characteristics and postoperative clinical outcomes were compared between patients with and without use of iMRI during EEA for acromegaly.

Results

Conventional navigation-guided surgery was performed in nine patients, and six underwent iMRI-guided EEA for acromegaly. Gross total resection (GTR) was obtained in the six (100%) patients in the iMRI group, and in four (44.4%) patients in the conventional group without iMRI. Postoperative clinical outcomes, including hormonal remission rate and surgical complications, were comparable between the two groups.

Conclusion

Although iMRI significantly increased the GTR rate, we found no direct evidence of increased hormonal remission rate by use of iMRI. It is important to confirm complete tumor resection carefully with not only iMRI findings, but also with intraoperative high-definition endoscopic direct visualization to increase the hormonal remission rate of acromegaly.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan

    Toshihiro Ogiwara, Takahide Hori, Yu Fujii, Takuya Nakamura, Yota Suzuki, Gen Watanabe, Yoshiki Hanaoka, Tetsuya Goto, Kazuhiro Hongo & Tetsuyoshi Horiuchi

  2. Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan

    Tetsuya Goto

Authors
  1. Toshihiro Ogiwara
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  2. Takahide Hori
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  3. Yu Fujii
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  4. Takuya Nakamura
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  5. Yota Suzuki
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  6. Gen Watanabe
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  7. Yoshiki Hanaoka
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  8. Tetsuya Goto
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  9. Kazuhiro Hongo
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  10. Tetsuyoshi Horiuchi
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Corresponding author

Correspondence to Toshihiro Ogiwara.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Ogiwara, T., Hori, T., Fujii, Y. et al. Effectiveness of the intraoperative magnetic resonance imaging during endoscopic endonasal approach for acromegaly. Pituitary 24, 690–697 (2021). https://doi.org/10.1007/s11102-021-01144-5

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  • DOI: https://doi.org/10.1007/s11102-021-01144-5

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