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The Zurich Pituitary Score predicts utility of intraoperative high-field magnetic resonance imaging in transsphenoidal pituitary adenoma surgery

  • Original Article - Pituitaries
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Abstract

Background

It is currently unclear if there are subsets of patients undergoing transsphenoidal surgery (TSS) in which intraoperative high-field magnetic resonance imaging (3T-iMRI) is particularly advantageous. We aimed to investigate whether a radiological grading scale predicts the utility of 3T-iMRI in pituitary adenoma (PA) TSS.

Methods

From a prospective registry, patients who underwent endoscopic TSS for PA using 3T-iMRI were identified. Adenomas were graded using the Zurich Pituitary Score (ZPS). We assessed improvement after 3T-iMRI in terms of gross total resection (GTR), residual volume (RV), and extent of resection (EOR).

Results

Among 95 patients, rates of conversion to GTR after 3T-iMRI decreased steadily from 33% for grade I to 0% for grade IV adenomas, with a statistically significant conversion rate only for grade I (p = 0.008) and grade II (p < 0.001). All grade I adenomas were completely resected after 3T-iMRI. Median RV change was statistically significant for grades I to III, but not for grade IV (p = 0.625). EOR improvement ranged from a median change of 0.0% (IQR 0.0–4.5%) for grade I to 4.4% (IQR 0.0–9.0%) for grade IV, with a significant improvement only for grades I to III (p < 0.05).

Conclusions

Interestingly, this study shows that clinical utility of 3T-iMRI is highest in the more “simple” adenomas (ZPS grades I–II) than for the more “complex” ones (ZPS grade III–IV). Grade I adenomas are amenable to GTR if 3T-iMRI is implemented. In grade III adenomas, EOR and RV can be improved to clinically relevant levels. Conversely, in grade IV adenomas, 3T-iMRI may be of limited use.

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Author notes

  1. Victor E. Staartjes and Carlo Serra contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Victor E. Staartjes, Carlo Serra, Nicolai Maldaner & Luca Regli

  2. Department of Neurosurgery, Tuscany School of Neurosurgery, University of Firenze, Florence, Italy

    Giovanni Muscas

  3. Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Oliver Tschopp

  4. Department of Otolaryngology, Head and Neck Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland

    Michael B. Soyka & David Holzmann

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  1. Victor E. Staartjes
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Correspondence to Carlo Serra.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Cantonal Ethics Committee Zürich, KEK St-V-Nr 2015-0142) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Electronic supplementary material

701_2019_4018_MOESM1_ESM.r

Supplementary Methods 1 Supplementary Content 1. R Code for the statistical analysis and figure rendering. The code was executed in R Version 3.5.1 (The R Foundation for Statistical Computing, Vienna, Austria) on a machine running Windows 10 (Microsoft Corp., Redmond, WA, USA). (R 17 kb)

Supplementary Figure 1

Extent of resection (EOR) in percent as measured (A) on intraoperative magnetic resonance imaging (MRI) and (B) on the 3-month follow-up MRI, stratified by Zurich Pituitary Score. An extreme outlier (Grade II) presenting with an intraoperative EOR of 19.6% is not depicted in order to preserve scale. (JPG 8296 kb)

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Staartjes, V.E., Serra, C., Maldaner, N. et al. The Zurich Pituitary Score predicts utility of intraoperative high-field magnetic resonance imaging in transsphenoidal pituitary adenoma surgery. Acta Neurochir 161, 2107–2115 (2019). https://doi.org/10.1007/s00701-019-04018-9

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