Intraoperative 3T MRI for pituitary macroadenoma resection: Initial experience in 73 consecutive patients

• Published in: Clinical neurology and neurosurgery 2014-11, Vol.126, p.143-149
• Main Authors: Fomekong, Edward, Duprez, Thierry, Docquier, Marie-Agnès, Ntsambi, Glennie, Maiter, Dominique, Raftopoulos, Christian
• Format: Article
• Language: English
• Subjects: Adenoma - surgery; Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Intraoperative MR imaging; Magnetic Resonance Imaging - methods; Magnetic Resonance Imaging - standards; Male; Microsurgery; Microsurgery - methods; Middle Aged; Monitoring, Intraoperative - methods; Monitoring, Intraoperative - standards; Neurology; Neurosurgery; NMR; Nuclear magnetic resonance; Pituitary gland; Pituitary macroadenomas; Pituitary Neoplasms - surgery; Sphenoid Bone - surgery; Transsphenoidal surgery; Treatment Outcome; Tumors; Twin magnetic resonance imaging suite; Young Adult
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2014.09.001

Abstract Objective To report a single-center experience with a 3T intraoperative magnetic resonance imaging (iMRI) to assess transsphenoidal microsurgery on pituitary macroadenomas. Methods In a dual, independent operating room (OR) magnetic resonance imaging (MRI) suite, the operating table with the anesthetized patient was moved on rail tracks once a supposed maximized resection was reached to the MRI room for intraoperative image acquisition and interpretation. After the assessment of the iMRI images, the neurosurgeon evaluated whether additional resection was still possible. The resection rates were assessed on iMRI and postoperative MRI at 3 months. Results A total of 73 macroadenomas benefited from an iMRI from March 2006 to October 2011. The gross total resection (GTR) rate at the time of the first iMRI was 58.9% ( n = 43). Based on the iMRI, eight patients (10.9%) underwent a second surgical resection. In 3 cases, the intraoperative imaging results were suspicious for a minor residue but not convincing enough for further surgery. Fortunately, the 3 months postoperative MRI control did not disclose any residual tumor in these cases. Finally, the GTR rate at the 3-month postoperative MRI increased to 72.6% ( n = 53). Conclusions 3T intraoperative MRI offered excellent quality images. Its use during transsphenoidal microsurgery on pituitary macroadenomas led to an increase not only in the extent of tumor resection (in 8 patients) but also in the rate of radical resections (69% instead of 60%). No complications due to the iMRI procedure were observed.