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Application of low-field intraoperative magnetic resonance imaging in transsphenoidal surgery for pituitary adenomas: technical points to improve the visibility of the tumor resection margin

  • Clinical Article - Brain Tumors
  • Published:
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Abstract

Background

Intraoperative magnetic resonance imaging (iMRI) is proven to be advantageous in transsphenoidal surgery (TSS) for pituitary adenomas. We evaluated the efficacy of low-field iMRI. Also, we described several techniques to enhance the visibility of the tumor resection margin.

Methods

Two hundred twenty-nine patients who underwent TSS using low-field iMRI were analyzed. iMRI was acquired in cases where the tumor removal was thought to meet the surgical goal after the tumor resection cavity had been packed with contrast-soaked cotton pledgets to improve the visibility of the tumor resection margin. Suspicious remnants were localized and explored using updated iMRI-based semi-real-time navigation. A merging technique was adopted for very small tumors. The final outcome was evaluated using postoperative 3-T diagnostic magnetic resonance imaging (MRI).

Results

Among 198 patients in whom total resection was attempted, total resection seemed to have been achieved in 184 patients based on iMRI findings. However, immediate postoperative MRI revealed remnant tumors in 4 out of 184 patients (false-negative rate, 2.2 %). The other 31 patients underwent intended subtotal resection of the tumors. Overall, in 47 patients (20.5 %), the use of iMRI led to further resection. Those patients benefited from the use of iMRI to achieve the planned extent of tumor resection.

Conclusions

iMRI maximizes the extent of resection and minimizes the possibility of unexpected tumor remnants in TSS for pituitary adenomas. It is essential to reduce imaging artifacts and enhance the visibility of the tumor resection margin during the use of low-field iMRI.

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Acknowledgments

The authors appreciate Mr. Dong Su Jang, a medical illustrator, for his beautiful work on the figures in this paper.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Yonsei Brain Research Institute, Pituitary Tumor Clinic, Yonsei University College of Medicine, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752, Republic of Korea

    Eui Hyun Kim, Min Chul Oh & Sun Ho Kim

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  1. Eui Hyun Kim
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  2. Min Chul Oh
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  3. Sun Ho Kim
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Corresponding author

Correspondence to Sun Ho Kim.

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Comment

Dr. Kim and colleagues have reviewed a large series of patients with pituitary ademonas in whom they used low-field intraoperative magnetic resonance imaging to monitor tumor removal. They found that when checking the scan after surgery to attempt complete removal, a small percentage of patients had not achieved complete resection (2/2 % false-negative rate). Furthermore, they used the results of the scan to extend the resection in over 20 % of patients (including those with subtotal resections). When reviewing this latter number, one questions whether the initial surgery would have been more aggressive if the MRI had not been available. However, given the number of patients analyzed and the surgeons' experience, this study will represent the gold standard for reference. It will make a great addition to the literature.

William Couldwell

USA

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Kim, E.H., Oh, M.C. & Kim, S.H. Application of low-field intraoperative magnetic resonance imaging in transsphenoidal surgery for pituitary adenomas: technical points to improve the visibility of the tumor resection margin. Acta Neurochir 155, 485–493 (2013). https://doi.org/10.1007/s00701-012-1608-6

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  • DOI: https://doi.org/10.1007/s00701-012-1608-6

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