Analysis of 137 patients who underwent endoscopic transsphenoidal pituitary adenoma resection under high-field intraoperative magnetic resonance imaging navigation

• Published in: World neurosurgery 2017-08, Vol.104, p.802-815
• Main Authors: Zhang, Huaping, Wang, Fuyu, Zhou, Tao, Wang, Peng, Chen, Xiaolei, Zahng, Jiashu, Zhou, Dingbiao
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Child; Child, Preschool; Combined Modality Therapy; Endoscopic endonasal transsphenoidal surgery; Endoscopy - methods; Female; Follow-Up Studies; Humans; Intraoperative magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Middle Aged; Neuronavigation; Neuronavigation - methods; Neurosurgery; Pituitary adenoma; Pituitary Neoplasms - diagnostic imaging; Pituitary Neoplasms - surgery; Postoperative Complications - diagnostic imaging; Radiotherapy, Adjuvant; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.04.056

Abstract Objective Endonasal resection of the pituitary embodies the minimally invasive concept. Pure endoscopic resection of pituitary adenoma has become the most popular surgical approach. Intraoperative magnetic resonance imaging (iMRI) systems have been in use for endoscopic resection of pituitary adenomas. The study aimed to evaluate the effectiveness of iMRI and neuroimaging navigation techniques during endoscopic endonasal transsphenoidal surgery of pituitary adenomas. Methods Data from 137 patients who underwent resection of endoscopic pituitary adenoma under 1.5-T iMRI navigation were collected and analyzed. Results Ninety-two patients underwent complete resection, and 45 patients had residual tumor on real-time iMRI. Twenty-three patients underwent further surgery, and total resection was achieved in 19. The extent of total resection increased from 67.15% to 81.02%. Intraoperative scanning revealed three patients with bleeding in the surgical area, which was successfully treated during the surgery. Review images 3 months after surgery showed 26 patients with residual tumor; 14 patients had the same volume as intraoperatively and 12 patients had a volume less than that observed intraoperatively. Residual tumor volume in the suprasellar region was less than that seen intraoperatively in 11 of 15 (73.3%) patients. Conclusion The use of iMRI and neuronavigation not only leads to a higher rate of tumor resection but also helps in detecting and removing hematomas in the surgical area. Three-month postoperative re-examinations of the extent of residual tumor were consistent with the intraoperative results. The residual tumor volume in the suprasellar region was usually less than that observed intraoperatively.