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  • Should we use intraoperative MRI if radical resection of pituiatry adenoma is planned?

    Final Number:

    David Netuka MD, PhD; Vaclav Masopust; Filip Kramar MD; Tomas Belsan; Vladimir Benes MD, PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Endoscopic techniques seem to enable more radical endonasal resections of pituitary adenomas. Intraoperative MRI seems to help to increase the radicality as well. Many studies present selected cases with intraoperative MRI. We present almost non-selected series of pituiatry adenomas treated endoscopically endonasally with intraoperative MRI.

    Methods: Prospective database, all sellar and perisellar lesions included. For evaluation histollogically proven adenomas treated in period 2009-2013 were selected. Altogether, 9 pituitary adenomas were resected transcranially, 437 endonasally. Intraoperative MRI was not performed in 24 cases (5,5%) due to various reasons (in majority of cases due to non-compatible pacemaker or other implant, extreme obesity, emergent night surgery, failure of transportation system, etc.). Altogether, 413 pituiatry adenomas were resected endonasally with intraoperative MRI.The goal of the surgery (either radical or subtotal resection) was set before the day of surgery.

    Results: Radical resection was planned in 244 cases. Subtotal resection was planned in cases of cavernous incasion lateral to ICA, in parasellar of pituitary adenoma invasion, complex recurrent or multilobulated adenoma. In 40 cases out of 244 (16,4%) any residual adenoma was disclosed on iMRI. Resection after intraoperative was attempted in 36 cases (14,8%). Final rate of radical resection was 230 (94,3%). Complications: CSF leakage in 4,1%, unilateral amaurosis 0,4%, mortality 0,4%.

    Conclusions: Routine application of intraoperative MRI in planned radical resection of pituitary adenoma is fully justified, enables to increase the rate of radical resections. Routine application of intraoperative MRI shows more clearly the value of this technique than highly selected series of intraoperative MRI. Supported byIGA 14256.

    Patient Care: The better rate of radical resections of pituiatry adenomas

    Learning Objectives: To clarify the value of intraoperative MRI in cases when radical resection of pituitary adenoma is planned before surgery


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