Research on the application of intraoperative magnetic resonance in transnasal ⁃sphenoidal surgery for pituitary adenoma

Abstract

Objective To discuss the application of the intraoperative magnetic resonance imaging (iMRI) ⁃ based neuronavigation system in transnasal ⁃ sphenoidal surgery for pituitary adenoma. Methods Thirty ⁃ eight pituitary adenomas were resected via nasal ⁃ sphenoidal approach with assistance of the American GE Signa 1.5T intraoperative magnetic resonance system associating German Brain LAB neuronavigation system. The clinical materials, iMRI quality and its influence on the surgical process and results were analyzed. Results Intraoperative scanning was performed 2 or 3 times in each patient, averaging (2.11 + 0.41) times. The scanning time was 3-5 min, and adding the packaging and transporting process, the whole procedure required 15-20 min. Posing the position, fixing the head rest and navigation registering took 32-40 min in all. So the total operation may last 47-60 min, averaging (51.20 + 0.66) min. The iMRI was used to scan and collect pictures. Residual tumor tissue was revealed in 11 cases. Eight of the 11 cases underwent total resection according to the new neuronavigation plan. The other 3 cases under⁃ went subtotal resection because the adenomas were tenacious and adhered closely to the surrounding significant structures. By using this iMRI system, the total resection rate (TRR) of adenoma increased from 71.05% (27/38) to 92.10% (35/38). It was raised by 21.05% (8/38; χ2 = 4.290, P = 0.018). There was no iMRI related complication occurred. Conclusion The application of iMRI ⁃ based neuronavigation technology in transnasal ⁃ sphenoidal operations for pituitary adenoma provides objective evidence for the guidance of surgical procedure and real time assessment of surgical results, which may lead to higher TRR and avoid deviation of navigation caused by brain⁃drift in transnasal⁃sphenoidal operation. DOI：10.3969/j.issn.1672⁃6731.2012.02.022