Use of intraoperative MRI in pituitary surgery

Abstract

Intraoperative magnetic resonance imaging (iMRI) during transphenoidal surgery has the potential to improve the safety, precision, and extent of tumor resection. It provides accurate guidance to and within the sella, provides precise information about the extent of resection, and alert the surgeon to the development of complications. Within the intraoperative MRI unit at the Brigham and Women's Hospital, Boston, 25 transsphenoidal procedures have been performed in 24 patients. Seventeen cases were reoperations. There were 23 pituitary adenomas (19 macroadenomas, 4 microadenomas). 1 Rathke's cyst, and 1 craniopharyngioma. iMRI was useful in guiding surgery toward the sella. All microadenomas were successfully resected. Total resection was achieved in 11 of 17 macroadenoma cases. iMRI helped identify 7 cases (of 13 with residual tumor) where residual tumor that was not obvious to the surgeon could be subsequently resected. Intraoperative MRI during transsphenoidal surgery offers excellent guidance to the sella, especially in cases of reoperation. In addition, it provides accurate data about the amount of residual tumor, which can often lead to further resection.