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Inoue S, Hasegawa H, Koizumi S, Umekawa M, Shono N, Kondo K, Saito N. Collision of pituitary neuroendocrine tumor and anterior clinoid meningioma treated with a two-stage minimally invasive surgical strategy: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 8:CASE24240. [PMID: 39133946 PMCID: PMC11323851 DOI: 10.3171/case24240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/23/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND The locations of pituitary neuroendocrine tumor (PitNET) and anterior clinoid meningioma (ACM) appear to be very close but essentially different, as the former is inside the sella turcica while the latter is in the intradural space. A collision tumor thus requires a specific treatment strategy but has been rarely reported. OBSERVATIONS A 77-year-old woman presented with progressive visual impairment due to significant compression of the optic apparatus by a collision of PitNET and ACM. With a minimally invasive two-stage therapeutic strategy, the ACM was first resected using an endoscopic mini-pterional approach, then the PitNET was removed with an endoscopic transnasal approach 8 weeks later, leading to significant improvement in visual function. The authors' literature search identified only 2 documented cases of a similar collision. LESSONS This case underscores the complexity of the decision-making process in the management of collision tumors and suggests the potential benefit of staged minimally invasive surgical interventions in preserving visual function. Further accumulation of cases is warranted for refining the treatment strategy. https://thejns.org/doi/10.3171/CASE24240.
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Affiliation(s)
- Shintaro Inoue
- Departments of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | | | - Satoshi Koizumi
- Departments of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Motoyuki Umekawa
- Departments of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Naoyuki Shono
- Departments of Neurosurgery, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Departments of Otorhinolaryngology, The University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Departments of Neurosurgery, The University of Tokyo, Tokyo, Japan
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Lin TM, Chen CY, Chung HW. Compressive optic neuropathy by pituitary adenoma: may making radiomics delta provide prognostic value after surgery? Eur Radiol 2023; 33:7479-7481. [PMID: 37782339 DOI: 10.1007/s00330-023-10274-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/31/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Te-Ming Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chieh-Yi Chen
- Department of Neurosurgery, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Hsiao-Wen Chung
- Graduate Institute of Biomedical Electronics and Bioinformatics, Department of Electrical Engineering, National Taiwan University, Taipei, 10617, Taiwan.
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Tsukamoto T, Miki Y. Imaging of pituitary tumors: an update with the 5th WHO Classifications-part 1. Pituitary neuroendocrine tumor (PitNET)/pituitary adenoma. Jpn J Radiol 2023:10.1007/s11604-023-01400-7. [PMID: 36826759 PMCID: PMC10366012 DOI: 10.1007/s11604-023-01400-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/04/2023] [Indexed: 02/25/2023]
Abstract
The pituitary gland is the body's master gland of the endocrine glands. Although it is a small organ, many types of tumors can develop within it. The recently revised fifth edition of the World Health Organization (WHO) classifications (2021 World Health Organization Classification of Central Nervous System Tumors and 2022 World Health Organization Classification of Endocrine and Neuroendocrine Tumors) revealed significant changes to the classification of pituitary adenomas, the most common type of pituitary gland tumor. This change categorized pituitary adenomas as neuroendocrine tumors and proposed the name to be revised to pituitary neuroendocrine tumor (PitNET). The International Classification of Diseases for Oncology behavior code for this tumor was previously "0" for benign tumor. In contrast, the fifth edition WHO classification has changed this code to "3" for primary malignant tumors as same to neuroendocrine tumor in other organs. Because the WHO classification made an important and significant change in the fundamental concept of the disease, in this paper, we will discuss the imaging diagnosis (magnetic resonance imaging, computed tomography, and positron emission tomography) of PitNET/pituitary adenoma in detail, considering these revisions as per the latest version of the WHO classification.
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Affiliation(s)
- Taro Tsukamoto
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, 1-4-3 Asahi-Machi, Abeno-Ku, Osaka, 545-8585, Japan.
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Banc A, Biousse V, Newman NJ, Kedar S. Ocular Optical Coherence Tomography in the Evaluation of Sellar and Parasellar Masses: A Review. Neurosurgery 2023; 92:42-67. [PMID: 36519859 PMCID: PMC10158913 DOI: 10.1227/neu.0000000000002186] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/15/2022] [Indexed: 12/23/2022] Open
Abstract
Compression of the anterior visual pathways by sellar and parasellar masses can produce irreversible and devastating visual loss. Optical coherence tomography (OCT) is a noninvasive high-resolution ocular imaging modality routinely used in ophthalmology clinics for qualitative and quantitative analysis of optic nerve and retinal structures, including the retinal ganglion cells. By demonstrating structural loss of the retinal ganglion cells whose axons form the optic nerve before decussating in the optic chiasm, OCT imaging of the optic nerve and retina provides an excellent tool for detection and monitoring of compressive optic neuropathies and chiasmopathies due to sellar and parasellar masses. Recent studies have highlighted the role of OCT imaging in the diagnosis, follow-up, and prognostication of the visual outcomes in patients with chiasmal compression. OCT parameters of optic nerve and macular scans such as peripapillary retinal nerve fiber layer thickness and macular ganglion cell thickness are correlated with the degree of visual loss; additionally, OCT can detect clinically significant optic nerve and chiasmal compression before visual field loss is revealed on automated perimetry. Preoperative values of OCT optic nerve and macular parameters represent a prognostic tool for postoperative visual outcome. This review provides a qualitative analysis of the current applications of OCT imaging of the retina and optic nerve in patients with anterior visual pathway compression from sellar and parasellar masses. We also review the role of new technologies such as OCT-angiography, which could improve the prognostic ability of OCT to predict postoperative visual function.
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Affiliation(s)
- Ana Banc
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Ophthalmology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sachin Kedar
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA;
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA;
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Hernández-Echevarría O, Cuétara-Lugo EB, Pérez-Benítez MJ, González-Gómez JC, González-Diez HR, Mendoza-Santiesteban CE. Bi-nasal sectors of ganglion cells complex and visual evoked potential amplitudes as biomarkers in pituitary macroadenoma management. Front Integr Neurosci 2022; 16:1034705. [PMID: 36506477 PMCID: PMC9730037 DOI: 10.3389/fnint.2022.1034705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
The study aimed to evaluate the retinal ganglion cell structure using optical coherence tomography and the visual pathway function employing visual evoked potentials in the diagnosis and monitoring of patients with pituitary macroadenoma. A descriptive, cross-sectional, and longitudinal study (3 and 12 months follow-up) was conducted on forty-two patients. Thirty-five age-matched healthy controls were used in the cross-sectional one. Full neuro-ophthalmological evaluation (structural and functional) was carried out including global and segmented retinal nerve fiber layer/ganglion cell complex analysis and amplitude and latency of P100 component in the electrophysiology. Statistical data analysis was conducted with R version 3.6.3 and Python version 3.8. Associations were evaluated using Spearman's correlations. Amplitude sensitivities were 0.999, and bi-nasal sectors of ganglion cell complex thickness specificities were 0.999. This structural parameter had the highest diagnostic value (area under curve = 0.923). Significant associations were found between bi-nasal sectors with amplitude at 12' (rho > 0.7, p < 0.01) and median deviation of the visual field (rho > 0.5, p < 0.01) at 3 months. Pre-surgical values of bi-nasal sectors and amplitude can predict post-surgically median deviation and amplitude (Oz, 12') at 3 months with r 2 > 0.5. Bi-nasal sectors of ganglion cell complex and visual evoked potentials P100 amplitude are efficient biomarkers of visual pathway damage for pituitary macroadenoma patients' management. Pre-surgical values of the bi-nasal sector and visual evoked potentials' amplitude could help to predict the restoration of parvocellular pathway traffic after decompression.
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Affiliation(s)
- Odelaisys Hernández-Echevarría
- Department of Neuro-ophthalmology, Cuban Institute of Ophthalmology “Ramón Pando Ferrer”, University of Medical Sciences of Havana, Havana, Cuba,*Correspondence: Odelaisys Hernández-Echevarría,
| | - Elizabeth Bárbara Cuétara-Lugo
- Department of Research and Academic, National Institute of Oncology and Radiobiology, University of Medical Sciences of Havana, Havana, Cuba
| | - Mario Jesús Pérez-Benítez
- Department of Research and Academic, National Institute of Oncology and Radiobiology, University of Medical Sciences of Havana, Havana, Cuba
| | - Julio César González-Gómez
- Department of Neuro-ophthalmology, Cuban Institute of Ophthalmology “Ramón Pando Ferrer”, University of Medical Sciences of Havana, Havana, Cuba
| | | | - Carlos E. Mendoza-Santiesteban
- Department of Neuro-ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Coral Gables, FL, United States
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Agosti E, Alexander AY, Pinheiro-Neto CD, Link MJ, Meyer FB, Peris-Celda M. Letter: Visual Field Defects in the Setting of Suprasellar Lesions: Could Vascularization Patterns of the Optic Chiasm Play a Role? Neurosurgery 2022; 91:e102-e103. [DOI: 10.1227/neu.0000000000002069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/19/2022] Open
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Alali AA, Hanagandi PB, Maralani PJ. Do We Need Gadolinium-Based Contrast Agents for Routine MRI Surveillance of Unoperated Pituitary Macroadenoma? AJNR Am J Neuroradiol 2022; 43:1024-1028. [PMID: 35738673 DOI: 10.3174/ajnr.a7554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The use of gadolinium-based contrast agents contributes to the cost of MR imaging and prolongs image-acquisition time. There are also recent concerns regarding gadolinium deposition, particularly in patients who require frequent follow-up MRIs. The purpose of this study was to assess whether gadolinium-based contrast agents are needed during MR imaging follow-up for unoperated pituitary macroadenoma. MATERIALS AND METHODS A total of 105 patients with unoperated pituitary macroadenoma who underwent follow-up MR imaging of the sella were included in this retrospective study. The craniocaudal dimension, cavernous sinus invasion grading, and optic pathway compression were assessed independently on coronal T2WI and compared with coronal T1-weighted images with gadolinium-based contrast agents (T1 postcontrast images). The agreement between the T2WI and T1 postcontrast images for the craniocaudal dimension was assessed using the intraclass correlation coefficient; for the cavernous sinus invasion and optic pathway compression, it was assessed using κ statistics. RESULTS There was excellent agreement for the craniocaudal dimensions between T2WI and T1 postcontrast images (intraclass correlation coefficient = 0.96, P < .001; 95% CI, 0.84-0.99). Additionally, there was almost-perfect agreement between cavernous sinus invasion and optic pathway compression between T2WI and T1 postcontrast images, with κ = 0.95 and 0.84, respectively (P < .001). CONCLUSIONS MR imaging of the sella without the use of gadolinium-based contrast agents could potentially be considered for the follow-up of unoperated pituitary macroadenomas. This choice can reduce the MR imaging examination cost and acquisition time and avoids potential adverse effects of gadolinium-based contrast agents.
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Affiliation(s)
- A A Alali
- From the Division of Neuroradiology (A.A.A.), King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - P B Hanagandi
- Department of Medical Imaging (P.B.H.), King Abdulaziz Medical City NGHA, Riyadh, Saudi Arabia
| | - P J Maralani
- Division of Neuroradiology (P.J.M.), Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Sasagawa Y, Aburano H, Ooiso K, Oishi M, Hayashi Y, Nakada M. Oculomotor nerve palsy in pituitary apoplexy associated with pituitary adenoma: a radiological analysis with fast imaging employing with steady-state acquisition. Acta Neurochir (Wien) 2021; 163:383-389. [PMID: 33128620 DOI: 10.1007/s00701-020-04632-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Oculomotor nerve palsy (ONP) occasionally occurs in cases of pituitary apoplexy (PA) associated with pituitary adenoma, but its mechanism remains unclear. Intracranial nerves are clearly visualized by fast-imaging employing with steady-state acquisition (FIESTA). Here, we assessed the oculomotor nerve compression in patients with PA associated with pituitary adenoma using FIESTA. METHODS Twenty-eight cases of PA, with or without ONP, were retrospectively reviewed. All patients had undergone preoperative FIESTA. Two neuroradiologists, unaware of the patient's clinical symptoms, evaluated the presence and location of oculomotor nerve compression due to the tumor. RESULTS Thirteen of the twenty-eight PA cases were associated with ONP. Tumor size and degree of cavernous sinus invasion were not significantly different between the ONP and non-ONP groups. Even in the ONP group, 8/13 (62%) tumors did not show cavernous sinus invasion. Via FIESTA, the presence of oculomotor nerve compression was confirmed in 11/13 (85%) and 5/15 (33%) cases in the ONP and non-ONP groups, respectively (p = 0.008). The radiologists' diagnoses of laterality of nerve compression (right or left) were consistent with the patient's affected eye. In the ONP group, the location of the nerve compression was located at the entry point to the cavernous sinus, the so-called oculomotor triangle, in 9/11 (82%) cases and intra cavernous sinus in 2/11 (18%) cases. CONCLUSION Compression at the oculomotor triangle is considered the main cause of ONP with PA in pituitary adenomas.
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Rutland JW, Delman BN, Huang KH, Verma G, Benson NC, Villavisanis DF, Lin HM, Bederson JB, Chelnis J, Shrivastava RK, Balchandani P. Primary visual cortical thickness in correlation with visual field defects in patients with pituitary macroadenomas: a structural 7-Tesla retinotopic analysis. J Neurosurg 2020; 133:1371-1381. [PMID: 31628280 PMCID: PMC7205160 DOI: 10.3171/2019.7.jns191712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/26/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Vision loss remains a debilitating complication of pituitary adenomas, although there is considerable variability in visual impairment before and after decompression surgery. Growing evidence suggests secondary damage to remote visual structures may contribute to vision loss in patients with chiasmatic compression. The present study leverages ultrahigh field 7-T MRI to study the retinotopic organization of the primary visual cortex (V1), and correlates visual defects with cortical thinning in V1 to characterize consequences of pituitary adenomas on the posterior visual system. METHODS Eight patients (4 males and 4 females, mean age 44.3 years) with pituitary adenomas who exhibited chiasmatic compression and visual field defects, as well as 8 matched healthy controls (4 males and 4 females, mean age 43.3 years), were scanned at 7-T MRI for this prospective study. Whole-brain cortical thickness was calculated using an automated algorithm. A previously published surface-based algorithm was applied to associate the eccentricity and polar angle with each position in V1. Cortical thickness was calculated at each point in the retinotopic organization, and a cortical thickness ratio was generated against matched controls for each point in the visual fields. Patients with adenoma additionally underwent neuroophthalmological examination including 24-2 Humphrey automated visual field perimetry. Pattern deviation (PD) of each point in the visual field, i.e., the deviation in point detection compared with neurologically healthy controls, was correlated with cortical thickness at corresponding polar and eccentricity angles in V1. RESULTS Whole-brain cortical thickness was successfully derived for all patients and controls. The mean tumor volume was 19.4 cm3. The median global thickness of V1 did not differ between patients (mean ± SD 2.21 ± 0.12 cm), compared with controls (2.06 ± 0.13 cm, p > 0.05). Surface morphometry-based retinotopic maps revealed that all 8 patients with adenoma showed a significant positive correlation between PD and V1 thickness ratios (r values ranged from 0.31 to 0.53, p < 0.05). Mixed-procedure analysis revealed that PD = -8.0719 + 5.5873*[Median V1 Thickness Ratio]. CONCLUSIONS All 8 patients showed significant positive correlations between V1 thickness and visual defect. These findings provide retinotopic maps of localized V1 cortical neurodegeneration spatially corresponding to impairments in the visual field. These results further characterize changes in the posterior visual pathway associated with chiasmatic compression, and may prove useful in the neuroophthalmological workup for patients with pituitary macroadenoma.
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Affiliation(s)
- John W Rutland
- 1Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Bradley N Delman
- 1Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
- 3Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | - Kuang-Han Huang
- 1Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
| | - Gaurav Verma
- 1Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
| | | | - Dillan F Villavisanis
- 1Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
| | - Hung-Mo Lin
- 5Department of Population Health Science and Policy, Mount Sinai Hospital; and
| | - Joshua B Bederson
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - James Chelnis
- 6Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raj K Shrivastava
- 2Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Priti Balchandani
- 1Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai
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Micko A, Hosmann A, Marik W, Bartsch S, Weber M, Knosp E, Wolfsberger S. Optimizing MR imaging for intraoperative image guidance in sellar pathologies. Pituitary 2020; 23:266-272. [PMID: 32170516 PMCID: PMC7181417 DOI: 10.1007/s11102-020-01035-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE With the advancement of extended endonasal approaches, the ability to surgically reach parasellar tumor extensions increase. The aim of the study was to propose an optimized imaging protocol for surgical guidance in the cavernous sinus (CS) for proper visualization structures at risk. METHODS Prospective case control analysis of 20 consecutive pituitary adenoma patients scheduled for endoscopic transnasal surgery. Assessment of the capability of three different MRI sequences (MPRAGE, VIBE, CISS) by 4 investigators to correctly visualize sellar and parasellar structures. Invasiveness and position of the normal pituitary gland were compared with the intraoperative findings. RESULTS The consensus between the 4 examiners to achieve the same results for all modalities was 40% for MPRAGE, 70% for VIBE and 60% for CISS sequences (p = 0.155). A consensus of Knosp Grade per patient was 80% for MPRAGE, 100% for VIBE and 90% for CISS (overall kappa 0.60). A higher Knosp Grade was found in MPRAGE sequences compared to the other sequences. Intraoperative status of invasiveness was correctly identified in 12/20 (60%) with MPRAGE, 19/20 (95%) with VIBE and 11/20 (55%) with CISS sequences. The position of the normal pituitary gland was most frequent evaluable in 15/20 (75%) and correctly identified in 12/15 (80%) cases. CONCLUSION Our data showed that VIBE sequences obtain the highest degree of consensus with intraoperative findings of invasiveness and position of the normal pituitary gland. VIBE sequences, due to their high spatial resolution and at the same time fast image acquisition could provide improved imaging for neuronavigation.
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Affiliation(s)
- Alexander Micko
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Wolfgang Marik
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sophie Bartsch
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Engelbert Knosp
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.
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Visual loss and recovery in chiasmal compression. Prog Retin Eye Res 2019; 73:100765. [DOI: 10.1016/j.preteyeres.2019.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 12/18/2022]
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Braileanu M, Hu R, Hoch MJ, Mullins ME, Ioachimescu AG, Oyesiku NM, Pappy A, Saindane AM. Pre-operative MRI predictors of hormonal remission status post pituitary adenoma resection. Clin Imaging 2019; 55:29-34. [PMID: 30731423 DOI: 10.1016/j.clinimag.2019.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/17/2018] [Accepted: 01/23/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Contrast-enhanced (CE) Constructive Interference in Steady State (CISS) and Volumetric Interpolated Breath-hold Examination (VIBE) are MRI sequences used to improve the detection of pituitary adenomas and adjacent cranial nerves. The purpose of this study was to assess image quality and identify imaging predictors of postoperative hormonal remission of functioning pituitary adenomas using CE-T1 weighted image (WI), T2WI, CE-CISS, and CE-VIBE MRI sequences. MATERIALS AND METHODS Patients with pre-operative CE-T1WI, T2WI, CE-CISS, and CE-VIBE pituitary MRI sequences were included in this institutional retrospective review. Three raters independently reviewed randomized sequences in a blinded fashion for adenoma characteristics and parasellar invasion. Subgroup analysis of hormonal remission was performed. RESULTS A total of 34 functioning pituitary adenoma patients were included (average age 39.3 ± 12.2; female n = 27), 30 of which had post-operative hormonal remission (n = 34; 88.2%). Compared to CE-T1WI, CE-CISS has significantly higher number of sequences rated "good" image quality (p = 0.02). Hormone remission was associated with decreased degrees of pre-operative internal carotid artery (ICA) contact and Knosp score (p ≤ 0.02) on all sequences except for Knosp score on T2WI. On receiver operating characteristic analysis, the area under curve for differentiating endocrine remission ranged from 0.88 to 0.92 for Knosp score and 0.85-0.93 for ICA contact, depending on sequence. CONCLUSION Extent of pituitary adenoma cavernous sinus invasion as measured by degrees of ICA contact and Knosp score is associated with postoperative endocrine outcomes. Given improved image quality, inclusion of CE-CISS may be helpful for pre-surgical planning.
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Affiliation(s)
- Maria Braileanu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America.
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America.
| | - Michael J Hoch
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America.
| | - Mark E Mullins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America.
| | - Adriana G Ioachimescu
- Department of Medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America; Department of Neurosurgery, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America.
| | - Nelson M Oyesiku
- Department of Neurosurgery, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America.
| | - Adlai Pappy
- Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America.
| | - Amit M Saindane
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, United States of America.
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