CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2023; 12(01): 051-058
DOI: 10.1055/s-0042-1743267
Original Article

Adjunctive Benefit of High-Field 3 Tesla MRI Guidance in Endoscopic Transsphenoidal Resection of Pituitary Adenoma

1   Department of Neurosurgery, Yashoda Hospital, Secunderabad, Telangana, India
Anandh Balasubramaniam
1   Department of Neurosurgery, Yashoda Hospital, Secunderabad, Telangana, India
Boyina Jagadeshwar Rajesh
1   Department of Neurosurgery, Yashoda Hospital, Secunderabad, Telangana, India
Krishna Kumar
1   Department of Neurosurgery, Yashoda Hospital, Secunderabad, Telangana, India
Nitin Manohar
2   Department of Anesthesia, Yashoda Hospital, Secunderabad, Telangana, India
Anjani Kumar
3   Department of Radiodiagnosis, Yashoda Hospital, Secunderabad, Telangana, India
› Author Affiliations
Funding None.


Introduction Pituitary adenomas (PAs) although benign, are difficult to resect intracranial tumors and their residues are associated with morbidity and reduced quality of life. Thus, gross total resection (GTR) is the goal for all PAs. Role of various modalities for better intraoperative visualization and thus improve resection of adenoma have been tested and each have their pros and cons. The aim of this paper is to analyze adjunctive benefit of high-field 3 Tesla intraoperative magnetic resonance imaging (iMRI) in PAs resection by endoscopic transnasal transsphenoidal surgery (eTSS).

Materials and Methods A total of 50 patients who underwent iMRI-guided eTSS were included. MRI findings in preoperative, intraoperative, and 3 months postoperative stage were compared. Adjunctive value of iMRI in improving resection rates of adenoma, postoperative endocrinological outcomes, need for adjuvant radiotherapy, and postoperative cerebrospinal fluid leak rates was assessed.

Results High-field 3 Tesla iMRI helped us to detect residues in 24 (48%) patients and iMRI-guided second look surgery increased our GTR rates from initial 52 to 80% and also helped us to identify and achieve 100% GTR in intrasellar residues and parasellar residues that were medial to medial carotid tangential line. With better resection rates, need for adjuvant radiotherapy was also reduced and only 2% received adjuvant radiotherapy. Average increase in surgical time with the use of iMRI was 38.78 minutes without any side effects pertaining to prolonged surgery.

Conclusion High-field iMRI is a useful adjunct in assessment and improvement in extent of resection of PA by endoscopic transsphenoidal surgery. Also, it was found beneficial in preserving normal anatomical gland and, thus, reducing the need for postoperative adjuvant hormonal and radiation therapy.

Publication History

Article published online:
16 May 2022

© 2021. Neurological Surgeons' Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Gold EB. Epidemiology of pituitary adenomas. Epidemiol Rev 1981; 3: 163-183
  • 2 Aflorei ED, Korbonits M. Epidemiology and etiopathogenesis of pituitary adenomas. J Neurooncol 2014; 117 (03) 379-394
  • 3 Alameda C, Lucas T, Pineda E. et al. Experience in management of 51 non-functioning pituitary adenomas: indications for post-operative radiotherapy. J Endocrinol Invest 2005; 28 (01) 18-22
  • 4 Greenman Y, Ouaknine G, Veshchev I, Reider-Groswasser II, Segev Y, Stern N. Postoperative surveillance of clinically nonfunctioning pituitary macroadenomas: markers of tumour quiescence and regrowth. Clin Endocrinol (Oxf) 2003; 58 (06) 763-769
  • 5 Ramm-Pettersen J, Berg-Johnsen J, Hol PK. et al. Intra-operative MRI facilitates tumour resection during trans-sphenoidal surgery for pituitary adenomas. Acta Neurochir (Wien) 2011; 153 (07) 1367-1373
  • 6 Bodhinayake I, Ottenhausen M, Mooney MA. et al. Results and risk factors for recurrence following endoscopic endonasal transsphenoidal surgery for pituitary adenoma. Clin Neurol Neurosurg 2014; 119: 75-79
  • 7 Raverot G, Vasiljevic A, Jouanneau E. Prognostic factors of regrowth in nonfunctioning pituitary tumors. Pituitary 2018; 21 (02) 176-182
  • 8 Brochier S, Galland F, Kujas M. et al. Factors predicting relapse of nonfunctioning pituitary macroadenomas after neurosurgery: a study of 142 patients. Eur J Endocrinol 2010; 163 (02) 193-200
  • 9 Hsu W, Li KW, Bookland M, Jallo GI. Keyhole to the brain: Walter Dandy and neuroendoscopy. J Neurosurg Pediatr 2009; 3 (05) 439-442
  • 10 Gandhi CD, Christiano LD, Eloy JA, Prestigiacomo CJ, Post KD. The historical evolution of transsphenoidal surgery: facilitation by technological advances. Neurosurg Focus 2009; 27 (03) E8
  • 11 Multani KM, Balasubramaniam A, Rajesh BJ, Kumar MS, Manohara N, Kumar A. Utility and pitfalls of high field 3 tesla intraoperative MRI in neurosurgery: a single centre experience of 100 cases. Neurol India 2020; 68 (02) 413-418
  • 12 DeKlotz TR, Chia SH, Lu W, Makambi KH, Aulisi E, Deeb Z. Meta-analysis of endoscopic versus sublabial pituitary surgery. Laryngoscope 2012; 122 (03) 511-518
  • 13 Dehdashti AR, Ganna A, Karabatsou K, Gentili F. Pure endoscopic endonasal approach for pituitary adenomas: early surgical results in 200 patients and comparison with previous microsurgical series. Neurosurgery 2008; 62 (05) 1006-1015 , discussion 1015–1017
  • 14 Serra C, Burkhardt J-K, Esposito G. et al. Pituitary surgery and volumetric assessment of extent of resection: a paradigm shift in the use of intraoperative magnetic resonance imaging. Neurosurg Focus 2016; 40 (03) E17
  • 15 Schwartz TH, Stieg PE, Anand VK. Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery 2006; 58 (1, Suppl): discussion ONS44–ONS51 ONS44-ONS51
  • 16 Gerlach R, du Mesnil de Rochemont R, Gasser T. et al. 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 2008; 63 (02) 272-284 , discussion 284–285
  • 17 Powell M. The value of intra-operative MRI in trans-sphenoidal pituitary surgery. Acta Neurochir (Wien) 2011; 153 (07) 1375-1376
  • 18 Berkmann S, Fandino J, Müller B, Remonda L, Landolt H. Intraoperative MRI and endocrinological outcome of transsphenoidal surgery for non-functioning pituitary adenoma. Acta Neurochir (Wien) 2012; 154 (04) 639-647
  • 19 Jho H-D, Carrau RL. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 1997; 87 (01) 44-51
  • 20 Charalampaki P, Reisch R, Ayad A. et al. Endoscopic endonasal pituitary surgery: surgical and outcome analysis of 50 cases. J Clin Neurosci 2007; 14 (05) 410-415
  • 21 Zaidi HA, De Los Reyes K, Barkhoudarian G. et al. The utility of high-resolution intraoperative MRI in endoscopic transsphenoidal surgery for pituitary macroadenomas: early experience in the advanced multimodality image guided operating suite. Neurosurg Focus 2016; 40 (03) E18
  • 22 Fomekong E, Duprez T, Docquier M-A, Ntsambi G, Maiter D, Raftopoulos C. Intraoperative 3T MRI for pituitary macroadenoma resection: Initial experience in 73 consecutive patients. Clin Neurol Neurosurg 2014; 126: 143-149
  • 23 Jankovski A, Francotte F, Vaz G. et al. Intraoperative magnetic resonance imaging at 3-T using a dual independent operating room-magnetic resonance imaging suite: development, feasibility, safety, and preliminary experience. Neurosurgery 2008; 63 (03) 412-424 , discussion 424–426
  • 24 Szerlip NJ, Zhang Y-C, Placantonakis DG. et al. Transsphenoidal resection of sellar tumors using high-field intraoperative magnetic resonance imaging. Skull Base 2011; 21 (04) 223-232