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The usefulness of intraoperative constructive interference in steady-state MRI sequencing during endoscopic transsphenoidal surgery
Author(s): ,
M. Kohta
Affiliations:
Kobe University Graduate School of Medicine, Department of Neurosurgery, Kobe, Japan
,
M. Taniguchi
Affiliations:
Kobe University Graduate School of Medicine, Department of Neurosurgery, Kobe, Japan
,
T. Nakai
Affiliations:
Kobe University Graduate School of Medicine, Department of Neurosurgery, Kobe, Japan
E. Kohmura
Affiliations:
Kobe University Graduate School of Medicine, Department of Neurosurgery, Kobe, Japan
EANS Academy. Kohta M. Oct 21, 2018; 225906; EP4041
Masaaki Kohta
Masaaki Kohta
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Abstract
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Background: Intraoperative MRI (iMRI) helps to increase the extent of resection during endoscopic transsphenoidal surgery (TSS). Constructive interference in steady-state (CISS) provides better visualization of the cranial nerves and cisternal space around parasellar region. In this study, we aimed to investigate the utility of intraoperative CISS (iCISS) during TSS.
Methods: 24 patients were underwent TSS using iMRI including iCISS between March 2015 and March 2018. All iMRI was performed using a 3 Tesla MRI (MAGNETOM Skyra, Siemens).
Result: The patients included 13 pituitary adenomas, 6 craniopharyngiomas, 3 chordomas, 1 Rathke´s cleft cyst, and 1 plasmacytoma. The average scanning time of iMRI was approximately 44 minutes, including 2 minutes for iCISS. Based on the iMRI, 12 patients underwent an additional surgical resection. After the additional resection, the number of GTR was increased from 8 to 14 (58%). In pituitary adenoma cases, the rate of GTR was increased from 23% to 69% (9/13) after iMRI. The iCISS images were superior to gadolinium-enhanced T1-weighted images and T2-weighted images for the decision of treatment strategy in 9 cases. Of these cases, we could detect the residual tumor, cranial nerves, or vessels in suprasellar region (3 cases), behind sellar region (3 cases), in cavernous sinus (2 cases), and in sellar region (1 case). In all cases, artifacts could be minimized by filling sphenoid sinus with saline solution.
Conclusions: iCISS is a useful tool to decide of treatment strategy during endoscopic TSS.
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