gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Multimodal navigation and intraoperative high-field magnetic resonance imaging in transsphenoidal surgery of complex pituitary adenomas

Meeting Abstract

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  • Michal Hlavac - Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg, Germany
  • Klaus Seitz - Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg, Germany
  • Thomas Schmidt - Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg, Germany
  • Rainer Wirtz - Neurochirurgische Klinik der Universität Ulm am Bezirkskrankenhaus Günzburg, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1757

doi: 10.3205/10dgnc228, urn:nbn:de:0183-10dgnc2281

Published: September 16, 2010

© 2010 Hlavac et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Feasibility and evaluation of multimodal neuronavigation combined with intraoperative 1,5 Tesla magnetic resonance imaging (MRI) in transspenoidal surgery of complex pituitary adenomas.

Methods: Prospective study of 19 patients with extensive or recurrent pituitary adenomas underwent navigated transsphenoidal adenomectomy followed by intraoperative MRI. When resectable tumor was indentified, resection was continued and imaging repeated until no more resectable tumor could be identified. Navigation for initial tumor resection was updated with intraoperative imaging for targeted resection of remnant tumor. Automatic segmentation of the peritumoral cerebral arteries from magnetic resonace angiography (MRA) was used in the navigation in cases of extrasellar tumor extension.

Results: Complete resection was intended in 13 patients, mass reduction in 6. The first intraoperative MRI confirmed this goal in 9 cases (8 complete resections, 1 mass reduction). Continued resection led to 3 complete and 2 subtotal resections in patients with intended complete resection increasing the proportion of complete tumor resection form 62% to 85%. In the remaining 5 patients, further significant tumor reduction followed imaging. In two patients suspicious findings on intraoperative MRI could not be verified operatively. Except for one cerebrospinal fluid fistula which needed operative repair, no significant adverse events were recorded.

Conclusions: In the selected group of patients with complex pituitary adenomas, the extent of tumor resection was considerably increased. MRI proved a valuable diagnostic tool in identifying tumor remnants intraoperatively. Identification of vascular structures with the navigation based on MRA proved helpful and reliable in the distorted anatomy of patients with large tumors.