Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging.
OBJECTIVE
The aim of the study was to evaluate the effect of intraoperative high-field (1.5 Tesla) magnetic resonance imaging (MRI) on the results of transsphenoidal surgery of GH-secreting pituitary macroadenomas.


METHODS
Twenty-three acromegalic patients (mean tumor size, 25 +/- 12 mm; untreated preoperative GH, 4.2-159 microg/l; IGF-I, 349-1111 microg/l) were investigated by intraoperative high-field MRI. If intraoperative imaging depicted an accessible tumor remnant, resection was continued.


RESULTS
In five patients intraoperative MRI led to further tumor removal, two of these met the consensus criteria for endocrine remission after 3 months. In two patients basal GH and oral glucose tolerance test (OGTT) were <2 microg/l, only IGF-I was slightly elevated, and in one patient GH was <5 microg/l and OGTT was 2 microg/l, with elevated IGF-I. Final intraoperative MRI showed no tumor remnants in 14 patients; eight of them met the consensus criteria for remission of acromegaly. In the patients with MRI showing incomplete removal (four suspect findings and five patients with intended partial removal) none was normalized.


CONCLUSIONS
With regard to the patients with a tumor configuration in whom complete tumor removal was considered (n = 18), intraoperative MRI increased the rate of endocrine normalization from 33 to 44% applying the consensus criteria, and improved endocrine outcome to 'nearly normalization' in another 17%. With regard to preoperative GH levels and tumor size, intraoperative MRI can help to achieve endocrine remission in patients who are normally considered not to be curable. However, taking GH as the tumor marker, even intraoperative high-field MRI was not able to detect tumor remnants in every case.
Fahlbusch
Rudolf
R
Department of Neurosurgery, University Erlangen-Nürnberg, Germany.
Keller
Boris v
Bv
Ganslandt
Oliver
O
Kreutzer
Jürgen
J
Nimsky
Christopher
C
D000172:Acromegaly / Q000473:pathology* / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000295:instrumentation / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D010911:Pituitary Neoplasms / Q000473:pathology / Q000601:surgery; D013100:Sphenoid Bone / Q000601:surgery; D016896:Treatment Outcome