gms | German Medical Science

Objective: We evaluated the clinical course of transsphenoidal surgery in nonfunctioning pituitary adenomas using intraoperative high field MRI control to analyse the benefit of the procedure.

Methods: From 2002 to 2007, 207 patients were operated on nonfunctioning pituitary adenomas with intraoperative MRI control (1.5T Siemens Sonata). The cases were classified into 3 groups: high relevance – intraoperative MRI led to complete tumor removal, moderate relevance – intraoperative MRI led to an extension of the resection without complete removal, low relevance – intraoperative MRI was without influence on the extent of the tumor resection.

Results: 207 patients suffering from nonfunctioning pituitary adenoma were operated, supported by intraoperative MRI. 170 of these were assessed as being completely resectable. In 93 of 170 patients, we found a primarily complete resection rated as low relevance of the procedure. In 77 cases resection was incomplete. In 8 of these 77 cases, no further resection was possible (low relevance), in 69 cases a further resection led to a complete removal in 49 cases (high relevance) and to an extension of the resection in 20 cases (moderate relevance). In the 37 cases, in which only a partial resection was intended, a further resection after MRI control was carried out in 20 cases (moderate relevance). In summary, the procedure was highly relevant in 49 cases, it increased the rate of complete tumor removal from 55% (93 of 170) to 84% (142 of 170). Moderate relevance was seen in 40 cases and low relevance in 118 cases.

Conclusions: In transsphenoidal surgery of nonfunctioning pituitary adenomas, Intraoperative MRI is a procedure that improves the rate of complete resection.