Abstract
Background
Intraoperative magnetic resonance imaging (iMRI) is an effective and proven tool in transsphenoidal endoscopic surgery. However, image interpretation is not always easy and can be hindered by the presence of blood, tumor remains or the displacement of surrounding structures. In this article we present a novel technique based on using intrasellar ballons to reduce these difficulties and facilitate the surgeon’s intraoperative assessment by iMRI.
Methods
Eighteen patients with pituitary macroadenomas underwent transsphenoidal surgery during 2013–2014 under low-field iMRI control (PoleStar N20, 0.15 T). Intrasellar balloons were used in all of them to assess the presence of tumoral remnants. We compared the findings in iMRI and postoperative high-field MRI control scans and also analyzed the number of intermediate imaging controls needed during surgery using this technique.
Results
In total, of the 18 patients, 14 underwent a complete resection. In the remaining four patients, a safe maximal resection was performed, leaving a remnant because of cavernous sinus invasion. In all cases, the balloons were a major help in distinguishing the anatomical structures from the tumoral remnants. Fewer imaging controls were required, and there were no false-positives or negative intraoperative findings. No complications related to the technique were registered.
Conclusion
The “intrasellar balloon technique” is a useful tool that facilitates surgeons’ intraoperative decision making. It is an important contribution to overcome the limitations of low-field iMRI as it provides a precise delineation of the resection margins, reduces false-positives and -negatives, and decreases the number of intermediate imaging controls required.
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References
Brell M, Roldán P, González E, Llinàs P, Ibáñez J (2013) First intraoperative magnetic resonance imaging in a Spanish hospital of the public healthcare system: initial experience, feasibility and difficulties in our environment. Neurocirugia (Astur) 24(1):11–21
Vitaz TW, Inkabi KE, Carrubba CJ (2011) Intraoperative MRI for transphenoidal procedures: short-term outcome for 100 consecutive cases. Clin Neurol Neurosurg 113(9):731–735
Bohinski RJ, Warnick RE, Gaskill-Shipley MF, Zuccarello M, van Loveren HR, Kormos DW, Tew JM Jr (2001) Intraoperative magnetic resonance imaging to determine the extent of resection of pituitary macroadenomas during transsphenoidal microsurgery. Neurosurgery 49(5):1133–1143
Coburger J, König R, Seitz K, Bäzner U, Wirtz CR, Hlavac M (2014) Determining the utility of intraoperative magnetic resonance imaging for transsphenoidal surgery: a retrospective study. J Neurosurg 120(2):346–356
Czyż M, Tabakow P, Lechowicz-Głogowska B, Jarmundowicz W (2011) Prospective study on efficacy of the low field intraoperative magnetic resonance imaging (iMRI) application in neurosurgical operations. Neurol Neurochir Pol 45(3):226–234
Gerlach R, du Mesnil de Rochemont R, Gasser T, Marquardt G, Reusch J, Imoehl L, Seifert V (2008) Feasibility of PoleStar N20, an ultra-low-field intraoperative magnetic resonance imaging system in resection control of pituitary macroadenomas: lessons learned from the first 40 cases. Neurosurgery 63:272–285
Gerlach R, de Rochemont RM, Gasser T, Marquardt G, Imoehl L, Seifert V (2011) Implementation of the ultra-low field intraoperative MRI PoleStar N20 during resection control of pituitary adenomas. Acta Neurochir Suppl 109:73–79
Hlavica M, Bellut D, Lemm D, Schmid C, Bernays RL (2013) Impact of ultra-low-field intraoperative magnetic resonance imaging on extent of resection and frequency of tumor recurrence in 104 surgically treated nonfunctioning pituitary adenomas. World Neurosurg 79(1):99–109
Ramm-Pettersen J, Berg-Johnsen J, Hol PK, Roy S, Bollerslev J, Schreiner T, Helseth E (2011) Intra-operative MRI facilitates tumour resection during trans-sphenoidal surgery for pituitary adenomas. Acta Neurochir 153(7):1367–1373
Tabakow P, Czyz M, Jarmundowicz W, Lechowicz-Głogowska E (2012) Surgical treatment of pituitary adenomas using low-field intraoperative magnetic resonance imaging. Adv Clin Exp Med 21(4):495–503
Wu JS, Shou XF, Jao CJ, Wang YF, Zhuang DX, Mao Y, Li SQ, Zhou LF (2009) Transsphenoidal pituitary macroadenomas resection guided by PoleStar N20 low-field intraoperative magnetic resonance imaging: comparison with early postoperative high-field magnetic resonance imaging. Neurosurgery 65:63–70
Bellut D, Hlavica M, Muroi C, Woernle CM, Schmid C, Bernays RL (2012) Impact of intraoperative MRI-guided transsphenoidal surgery on endocrine function and hormone substitution therapy in patients with pituitary adenoma. Swiss Med Wkly 142:w13699
Berkmann S, Fandino J, Müller B, Remonda L, Landolt H (2012) Intraoperative MRI and endocrinological outcome of transsphenoidal surgery for non-functioning pituitary adenoma. Acta Neurochir (Wien) 154(4):639–647
Ahn JY, Jung JY, Kim J, Lee KS, Kim SH (2008) How to overcome the limitations to determine the resection margin of pituitary tumours with low-field intra-operative MRI during trans-sphenoidal surgery: usefulness of gadolinium-soaked cotton pledgets. Acta Neurochir (Wien) 150(8):763–771
Buchfelder M, Schlaffer SM (2012) Intraoperative magnetic resonance imaging during surgery for pituitary adenomas: pros and cons. Endocrine 42(3):483–495
Kim EH, Oh MC, Kim SH (2013) 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(3):485–493
Nimsky C, Ganslandt O, Tomandl B, Buchfelder M, Fahlbusch R (2002) Low-field magnetic resonance imaging for intraoperative use in neurosurgery: a 5-year experience. Eur Radiol 12(11):2690–2703
Kuge A, Kikuchi Z, Sato S, Sakurada K, Takemura S, Kayama T (2013) Practical use of a simple technique, insertion of wet cotton pledgets into the tumor resection cavity in transsphenoidal surgery of pituitary tumors, for a better comparison between pre- and intraoperative high-field magnetic resonance images. J Neurol Surg A Cen Eur Neurosurg 74(6):366–372
Gering DT, Nabavi A, Kikinis R, Hata N, O’Donnell LJ, Grimson WE, Jolesz FA, Black PM, Wells WM 3rd (2001) An integrated visualization system for surgical planning and guidance using image fusion and an open MR. J Magn Reson Imaging 13(6):967–975
Fahlbusch R, Bv K, Ganslandt O, Kreutzer J, Nimsky C (2005) Transsphenoidal surgery in acromegaly investigated by intraoperative high-field magnetic resonance imaging. Eur J Endocrinol 153(2):239–248
Nimsky C, Ganslandt O, Von Keller B, Romstöck J, Fahlbusch R (2004) Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients. Radiology 233(1):67–78
Nimsky C, Ganslandt O, Fahlbusch R (2005) Comparing 0.2 Tesla with 1.5 Tesla intraoperative magnetic resonance imaging analysis of setup, workflow, and efficiency. Acad Radiol 12(9):1065–1079
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All procedures were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
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Jiménez, P., Brell, M., Sarriá-Echegaray, P. et al. “Intrasellar Balloon Technique” in intraoperative MRI guided transsphenoidal endoscopic surgery for sellar region tumors. Usefulness on image interpretation and extent of resection evaluation. Technical note. Acta Neurochir 158, 445–449 (2016). https://doi.org/10.1007/s00701-015-2697-9
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DOI: https://doi.org/10.1007/s00701-015-2697-9