Fahlbusch R, Ganslandt O, Buchfelder M, Schott W, Nimsky C
Department of Neurosurgery, University Erlangen-Nürnberg, Erlangen, Germany.
J Neurosurg. 2001 Sep;95(3):381-90. doi: 10.3171/jns.2001.95.3.0381.
The aim of this study was to evaluate whether intraoperative magnetic resonance (MR) imaging can increase the efficacy of transsphenoidal microsurgery, primarily in non-hormone-secreting intra- and suprasellar pituitary macroadenomas.
Intraoperative imaging was performed using a 0.2-tesla MR imager, which was located in a specially designed operating room. The patient was placed supine on the sliding table of the MR imager, with the head placed near the 5-gauss line. A standard flexible coil was placed around the patient's forehead. Microsurgery was performed using MR-compatible instruments. Image acquisition was started after the sliding table had been moved into the center of the magnet. Coronal and sagittal T1-weighted images each required over 8 minutes to acquire, and T2-weighted images were obtained optionally. To assess the reliability of intraoperative evaluation of tumor resection, the intraoperative findings were compared with those on conventional postoperative 1.5-tesla MR images, which were obtained 2 to 3 months after surgery. Among 44 patients with large intra- and suprasellar pituitary adenomas that were mainly hormonally inactive, intraoperative MR imaging allowed an ultra-early evaluation of tumor resection in 73% of cases; such an evaluation is normally only possible 2 to 3 months after surgery. A second intraoperative examination of 24 patients for suspected tumor remnants led to additional resection in 15 patients (34%).
Intraoperative MR imaging undoubtedly offers the option of a second look within the same surgical procedure, if incomplete tumor resection is suspected. Thus, the rate of procedures during which complete tumor removal is achieved can be improved. Furthermore, additional treatments for those patients in whom tumor removal was incomplete can be planned at an early stage, namely just after surgery.
本研究旨在评估术中磁共振(MR)成像是否能提高经蝶窦显微手术的疗效,主要针对非激素分泌性鞍内和鞍上垂体大腺瘤。
术中成像使用一台0.2特斯拉的MR成像仪,该成像仪位于一个特别设计的手术室中。患者仰卧于MR成像仪的滑动台上,头部靠近5高斯线。一个标准的柔性线圈置于患者前额周围。使用与MR兼容的器械进行显微手术。在滑动台移入磁体中心后开始图像采集。冠状位和矢状位T1加权图像的采集各需8分钟以上,T2加权图像则视情况获取。为评估肿瘤切除术中评估的可靠性,将术中发现与术后2至3个月获得的传统术后1.5特斯拉MR图像上的发现进行比较。在44例主要为无激素活性的鞍内和鞍上垂体大腺瘤患者中,术中MR成像在73%的病例中实现了对肿瘤切除的超早期评估;而这种评估通常在术后2至3个月才能进行。对24例疑似肿瘤残留的患者进行的第二次术中检查导致15例患者(34%)进行了额外切除。
如果怀疑肿瘤切除不完全,术中MR成像无疑提供了在同一手术过程中再次检查的选择。因此,可以提高实现肿瘤完全切除的手术比例。此外,对于那些肿瘤切除不完全的患者,可以在早期即手术后立即规划额外的治疗。