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Is Intraoperative MRI beneficial in the time of endoscopic transsphenoidal pituitary surgery?
EANS Academy. Pala A. Sep 27, 2019; 275967; EP04066
Abstract
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Introduction: Endoscopic technique has been routinely established in transsphenoidal surgery in last decades in order to improve intraoperative visualization of parasellar structures. We have evaluated the additional role of iMRI in the endoscopic transsphenoidal pituitary surgery.
Methods: We conducted a retrospective monocenter data analysis of patients treated by iMRI assisted endoscopic transsphenoidal surgery between 2015-2018. 100 consecutive cases were evaluated. Detailed volumetric tumor analysis before surgery, intraoperatively and three months after surgery was performed (Brainlab, Elements). Demographic data, clinical symptoms as well as complications were evaluated.
Results: Out of 100 pts, 50% were graded as Knosp 0-2. Mean age was 54 years and mostly male patients were treated (61%). Mean tumor volume was 8.2 cm3. Non-functioning adenoma was the most common tumor (72%). Recurrent adenoma was treated in 15%. Additional resection after iMRI was performed in 34%. Tumor remnants were significantly smaller in follow-up MRI than in iMRT (p< 0.001), Simultaneously, GTR-rates were significantly higher (p< 0.001). Significantly smaller tumor remnant was found even in subgroups Knosp 0-2 (p=0.043) and Knosp 3-4 (p< 0.001), while proportional GTR rates were significantly higher with iMRI only in Knosp 3-4 adenomas (p< 0.001). Revision due to cerebrospinal fluid fistula was found in 7 %. Out of 40 pts with preoperative chiasma syndrome, 85% (34) improved after surgery. Only in one patient visual deterioration was diagnosed after surgical treatment.
Conclusion:
Intraoperative MRI significantly increases volumetric EoR in endoscopic transsphenoidal surgery independent on Knosp grading. The value of iMRI in endoscopic transsphenoidal surgery lies mainly in large and complex adenomas. Nevertheless,individual patients with Knosp 0-2 tumors may profit from iMRI. Simultaneously, iMRI use is not associated with higher complications or infection rates and results in excellent improvement of visual disturbances in comparison to actual literature.
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