Ces radiol. 2020, 74(1):62-67 | DOI: 10.55095/CesRadiol2020/011

Intraoperative magnetic resonance imaging in a traditional imaging suite during endonasal pituitary adenoma resectionOriginal article

Petr Vacek¹, Radek Tupý², Vladan Hrabě³, Jan Mraček¹, Ondřej Sebera³, Vladimír Přibáň¹

¹ Neurochirurgická klinika LF UK a FN, Plzeň

² Klinika zobrazovacích metod LF UK a FN, Plzeň

³ Otorinolaryngologická klinika LF UK a FN, Plzeň

Aim: Although the usage of an endoscope during the transsphenoidal approach to pituitary adenomas significantly extended the surgeon's field of view, we are still not able to visualize suprasellar and parasellar spaces. We are presenting our experience with intraoperative magnetic resonance imaging in traditional MRI suite during endoscopic endonasal pituitary adenoma resection in a form of a retrospective study.

Methods: From March 2008 to February 2013 we performed endoscopic endonasal pituitary adenoma resection on 50 patients at our department. Surgical outcomes were compared between the first 25 patients (no iMRI) and the second 25 patients with whom iMRI was used. We evaluated not only the number of total resections in both groups, but also the prolongation of the time of the surgery in the second group. We also evaluated the progression of ophthalmic and endocrinological symptoms in both groups and the rate of complications.

Results: Intraoperative magnetic resonance imaging was successfully performed on all of the patients within the second group without any complications connected with the transport of the patient or the execution of the procedure. The average length of the surgery was prolonged from 205 to 238 minutes (marginally statistically insignificant). We achieved total adenoma resection in seven cases (28%) in the first group and in 16 cases (64%) in the second group (statistically significant difference). Within both of the groups, we did not detect any statistically significant differences in diabetes insipidus occurrence, in postoperative visual field improvement, and not even in intraoperative and postoperative cerebrospinal fluid leak.

Conclusion: The possibility of monitoring the extent of the pituitary adenoma resection during endonasal approach with an intraoperative magnetic resonance imaging significantly improves the results of the surgery. In case of favourable building layout, performing this procedure in traditional MRI suite is safe.

Keywords: pituitary adenoma, intraoperative magnetic resonance imaging, endonasal endoscopic surgery, total resection

Grants and funding:

Podpořeno MZ ČR - RVO (Fakultní nemocnice Plzeň PNPI, 00669806).

Accepted: January 30, 2020; Published: March 1, 2020  Show citation