Department of Neurosurgery, University of Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.
Endocrine. 2012 Dec;42(3):483-95. doi: 10.1007/s12020-012-9752-6. Epub 2012 Jul 26.
Surgery for pituitary adenomas still remains a mainstay in their treatment, despite all advances in sophisticated medical treatments and radiotherapy. Total tumor excision is often attempted, but there are limitations in the intraoperative assessment of the radicalism of tumor resection by the neurosurgeon. Standard postoperative imaging is usually performed with a few months delay from the surgical intervention. The purpose of this report is to review briefly the facilities and kinds of intraoperative magnetic resonance imaging for all physician and surgeons involved in the management of pituitary adenomas on the basis of current literature. To date, there are several low- and high-field magnetic resonance imaging systems available for intraoperative use and depiction of the extent of tumor removal during surgery. Recovery of vision and the morphological result of surgery can be largely predicted from the intraoperative images. A variety of studies document that depiction of residual tumor allows targeted attack of the remnant and extent the resection. Intraoperative magnetic resonance imaging offers an immediate feedback to the surgeon and is a perfect quality control for pituitary surgery. It is also used as a basis of datasets for intraoperative navigation which is particularly useful in any kind of anatomical variations and repeat operations in which primary surgery has distorted the normal anatomy. However, setting up the technology is expensive and some systems even require extensive remodeling of the operation theatre. Intraoperative imaging prolongs the operation, but may also depict evolving problems, such as hematomas in the tumor cavity. There are several artifacts in intraoperative MR images possible that must be considered. The procedures are not associated with an increased complication rate.
尽管在复杂的医学治疗和放射治疗方面取得了所有进展，但针对垂体腺瘤的手术仍然是其治疗的主要手段。通常会尝试进行肿瘤全切除，但神经外科医生在术中评估肿瘤切除的彻底性方面存在局限性。标准的术后影像学检查通常在手术干预后几个月进行。本报告旨在根据当前文献简要回顾所有参与垂体腺瘤管理的医生和外科医生使用的术中磁共振成像设备和种类。迄今为止，有几种低场和高场磁共振成像系统可用于术中使用，并在手术过程中描绘肿瘤切除的范围。术中图像可以很大程度上预测视力的恢复和手术的形态学结果。多项研究表明，残余肿瘤的描绘可以靶向攻击残余肿瘤并扩大切除范围。术中磁共振成像为外科医生提供了即时反馈，是垂体手术的完美质量控制手段。它还可用作术中导航的数据集基础，在任何解剖结构变异和需要重复手术的情况下特别有用，因为初次手术已经改变了正常解剖结构。然而，建立该技术的成本很高，有些系统甚至需要对手术室进行广泛改造。术中成像会延长手术时间，但也可能会描绘出不断出现的问题，例如肿瘤腔内的血肿。术中磁共振图像中可能存在几种必须考虑的伪影。这些操作与并发症发生率增加无关。
