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J Neurol Surg B Skull Base 2022; 83(06): 646-652
DOI: 10.1055/a-1924-8166
Review Article

The Value of Intraoperative Magnetic Resonance Imaging in Endoscopic Endonasal Resection of Pituitary Adenoma

Aneek Patel 
1   Department of Neurosurgery, New York University Langone Health, New York, New York, United States
,
Yosef Dastagirzada
1   Department of Neurosurgery, New York University Langone Health, New York, New York, United States
,
Carolina Benjamin
2   Department of Neurosurgery, University of Miami Health System, Miami, Florida, United States
,
Seth Lieberman
3   Department of Otolaryngology, New York University Langone Health, New York, New York, United States
,
Richard Lebowitz
3   Department of Otolaryngology, New York University Langone Health, New York, New York, United States
,
John G. Golfinos 
1   Department of Neurosurgery, New York University Langone Health, New York, New York, United States
,
Donato Pacione
1   Department of Neurosurgery, New York University Langone Health, New York, New York, United States
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Abstract

Background Intraoperative magnetic resonance images (iMRIs) have been variably adopted by some centers to help increase the rate of gross total resection (GTR) of pituitary adenomas. In this comparative study, we report our institution's experience with using iMRIs for endoscopic endonasal approach (EEA) pituitary adenoma resection to better elucidate its role and potential value for pituitary surgery.

Methods All adult patients who underwent EEA for a pituitary adenoma from January 2013 to September 2021 were retrospectively reviewed. GTR was defined as no residual tumor or recurrence on postoperative imaging within 6 months. Univariate analysis followed by multivariate analysis was performed with GTR as the categorical endpoint. To measure the independent effect of iMRI on GTR, propensity score matching was then performed.

Results A total of 351 pituitary adenoma patients who underwent EEA were identified. The mean age was 51.2 (range: 18–90) years and 196 (55.8%) patients were female. iMRI was utilized in 87 (24.8%) cases. The overall rate of GTR was 69.2%. On multivariate analysis, low Knosp grade, low tumor volume, and the use of iMRI were predictive of GTR. There was no difference in the need for desmopressin or hydrocortisone at 90 days postoperatively.

Conclusion At our institution, we report a significant absolute increase in GTR rates of 16.4% for patients undergoing an iMRI. Among iMRI patients who did not have GTR, the majority of residuals were intentionally left behind after being deemed too risky to pursue. Overall, this study suggests the high value that iMRI adds to endoscopic pituitary adenoma surgery.

Keywords

intraoperative MRI - endoscopic endonasal approach - pituitary adenoma - cavernous sinus - suprasellar cistern


Publication History

Received: 19 May 2022

Accepted: 03 August 2022

Accepted Manuscript online:
16 August 2022

Article published online:
28 September 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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