Author(s): Hannan C.; Alalade A.F.; Gilkes C.; Radon M.
Source: Journal of Neurological Surgery, Part B: Skull Base; Feb 2019; vol. 80
Publication Date: Feb 2019
Publication Type(s): Conference Abstract
Abstract:Objectives: A dual approach of endoscopic endonasal pituitary surgery with intraoperative MRI has been advocated as providing increased total resection rates, better visualization and enhanced illumination. Since the opening of our iMRI suite in May 2017, we report our experience with a 3T iMRI to assess endoscopic endonasal pituitary adenoma surgery. Subjects: Between May 2017 and June 2018, twenty-one patients had iMRI-assisted endoscopic resection of pituitary tumors. They consisted of 16 macroadenomas, 3 giant adenomas (>4 cm), and 2 functioning microadenomas. Method(s): The authors prospectively reviewed all endoscopic transsphenoidal surgeries performed in the iMRI suite of their institution. Following endoscopic resection of the pituitary tumor, iMRI was performed when maximal resection was felt to have been achieved. All radiological images were independently reviewed by a neuroradiologist, and the histopathology results were checked and confirmed. If resectable residual tumor was identified, the patient underwent further resection and iMRI was repeated. A 3T Skyra scanner (SIEMENS) equipped with a NORAS coil was used for iMRI. Result(s): In 14 of the cases, the initial iMRI confirmed the intraoperative assessment: GTR was obtained in 9, an anticipated unresectable residuum in 3, and suprasellar residual component requiring craniotomy in 2 giant tumors. In seven (33%) cases, the iMRI findings prompted an unanticipated return to theater. Further tumor resection was performed in four (19%), resulting in a GTR in two cases. In three cases, residual tumor was not found on surgical reexploration. Permanent DI was noted in 29% of the patients. Conclusion(s): Rates of complete adenoma resection improved with the use of iMRI, and tumor volume reduction improved in cases where the entire tumor could not be resected. There was an increased rate of postoperative diabetes insipidus and the cases took longer. Recurrence rates over a longer follow-up period and the cost-effectiveness of this dual approach are criteria we intend to investigate in the future.