gms | German Medical Science

Objective: Surgical therapy remains a mainstay in the treatment of large pituitary adenomas. Especially for large and recurrent tumors with infiltration of adjacent neurovascular structures, intraoperative MRI enables direct resection control with the possibility to continue resection under neuronavigational support. We report our experience of the iMRI-guided surgical therapy for large pituitary adenomas.

Method: A series of fifteen patients after iMRI surgery for difficult large pituitary adenomas were analyzed for the following factors: Preoperative symptoms and MR imaging, intraoperative microsurgical findings, intraoperative MR imaging and residual tumor, surgical time, peri- and postoperative morbidities, histology and follow-up.

Results: 14 (93%) of the resections were performed by a transsphenoidal, 1 (7%) by pterional approach. Intraoperative MRI revealed residual tumor with subsequently continued resection in 10 (67%) of the cases. Of these, 7 (70%) revealed unexpected residual tumor tissue which might have led to subtotal resections in conventional surgery. No peri- and postoperative complications were noticed due to the use of iMRI.

Conclusions: High-field iMRI is a safe and reliable tool to increase total resection rates of large pituitary adenomas. Yet, its use needs to be balanced against high costs and extended surgery times. IMRI should be a standard procedure in problematic pituitary adenomas with infiltration of adjacent neurovascular structures, whereas its use for smaller pathologies might not be necessary.