Skull Base 2011; 21(4): 223-232
DOI: 10.1055/s-0031-1277262
ORIGINAL ARTICLE

© Thieme Medical Publishers

Transsphenoidal Resection of Sellar Tumors Using High-Field Intraoperative Magnetic Resonance Imaging

Nicholas J. Szerlip1 , Yi-Chen Zhang6 , Dimitris G. Placantonakis1 , 5 , Marc Goldman1 , Kara B. Colevas1 , David G. Rubin1 , 5 , Eric J. Kobylarz2 , Sasan Karimi4 , Monica Girotra3 , Viviane Tabar1
  • 1Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York
  • 2Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York
  • 3Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York
  • 4Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York
  • 5Department of Neurological Surgery, Weill Cornell Medical College, New York
  • 6Albert Einstein College of Medicine, Bronx, New York
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Publikationsverlauf

Publikationsdatum:
03. Mai 2011 (online)

ABSTRACT

There has been increasing experience in the utilization of intraoperative magnetic resonance imaging (iMRI) for intracranial surgery. Despite this trend, only a few U.S centers have examined the use of this technology for transsphenoidal resection of tumors of the sella. We present the largest series in North America examining the role of iMRI for pituitary adenoma resection. We retrospectively reviewed our institutional experience of 59-patients who underwent transsphenoidal procedures for sellar and suprasellar tumors with iMRI guidance. Of these, 52 patients had a histological diagnosis of pituitary adenoma. The technical results of this subgroup were examined. A 1.5-T iMRI was integrated with the BrainLAB (Feldkirchen, Germany) neuronavigation system. The majority (94%) of tumors in our series were macroadenomas. Seventeen percent of tumors were confined to the sella, 49% had suprasellar extensions without involvement of the cavernous sinus, 34% had frank cavernous sinus invasion. All patients underwent at least one iMRI, and 19% required one or more additional sets of intraoperative imaging. In 58% of patients, iMRI led to the surgeon attempting more resection. A gross total resection was obtained in 67% of the patients with planned total resections. There was one case of permanent postoperative diabetes insipidus and no other instances of new hormone replacement. In summary, iMRI was most useful for tumors of the sella with and without suprasellar extension where the information from the iMRI extended the complete resection rate from 40 to 72% and 55 to 88%, respectively. As one would expect, it did not substantially increase the rate of resection of tumors with cavernous sinus invasion. Overall, iMRI was particularly useful in guiding resection safely, aiding in clinical decision making, and allowing identification and preservation of the pituitary stalk and normal pituitary gland. Limitations of the iMRI include a need for additional personnel and training as well as additional operative time, which diminishes over time as personnel learn to optimize workflow efficiency. Additional costs are mitigated in part by using the iMRI as an immediate postoperative scan. Other data emerging from our experience suggest that preservation of normal gland and thus avoidance of hypopituitarism may be improved by iMRI use, but longer follow-up periods are required to test this conclusion. iMRI can detect unsuspected complications sooner than routine postoperative imaging, potentially leading to improved outcomes. However, larger studies are needed.

REFERENCES

Viviane Tabar, M.D. 

Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center

1275 York Avenue, New York, NY 10065

eMail: tabarv@mskcc.org