gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

The benefit of iMRI assisted endoscopic transsphenoidal approach compared to microsurgical technique in pituitary surgery

Meeting Abstract

  • Andrej Pala - Universitätsklinikum Ulm am Standort Günzburg, Abteilung für Neurochirurgie, Sektion Periphere Nervenchirurgie, Oberelchingen, Deutschland
  • Andreas Knoll - Günzburg, Deutschland
  • Gwendolin Etzrodt-Walter - Ulm, Deutschland
  • Jan Coburger - Neurochirurgische Klinik der Universität Ulm, Standort Günzburg, Günzburg, Deutschland
  • Christian Rainer Wirtz - Bezirkskrankenhaus Günzburg, Neurochirurgische Klinik der Universität Ulm, Günzburg, Deutschland
  • Michal Hlavac - Günzburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.26.04

doi: 10.3205/17dgnc158, urn:nbn:de:0183-17dgnc1584

Published: June 9, 2017

© 2017 Pala et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: The routine use of intraoperative MRI (iMRI) helps to achieve gross total resection (GTR) in transnasal transsphenoidal pituitary surgery. We have analyzed the added value of iMRI on extent of resection in endoscopic compared to microsurgical transsphenoidal approach and evaluated the endocrine outcome between both techniques.

Methods: A total of 96 patients with pituitary adenoma were included. A number of 28 consecutive patients underwent endoscopic transnasal transsphenoidal tumor resection. Historic cohort of 68 patients who underwent microsurgical transsphenoidal adenomectomy have been used for the analysis. We evaluated the residual tumor volume after conducting iMRI using intraoperative and late postoperative volumetric analysis 3 months after surgery. Knosp classification was used to stratify the invasive growth pattern of adenomas in cavernous sinus. Pituitary function was evaluated. Mann-Whitney-U, Fisher exact test and binary logistic regression were used for analysis.

Results: The most common histological subtype was non-functioning adenoma (N=65, 67.7%). There were significantly less additional resections after conducting iMRI in the endoscopic group (p=0.042) especially in Knosp 0-2 adenomas (p=0.029). We found no significant difference in Knosp 3-4 adenomas (p=0.520). The use of endoscopic approach was associated with smaller intraoperative tumor volume (p=0.023). There was no significant difference with regard to postoperative tumor volume between both techniques (p=0.228). No significant difference was noted with regard to surgical complications between both cohorts. Satisfactory results of pituitary function were significantly associated with an endoscopic approach (p=0.001).

Conclusion: With endoscopic approach, significantly better endocrine outcome has been achieved especially in Knosp 0-2 pituitary adenomas. Furthermore, iMRI assisted transsphenoidal endoscopic technique was associated with less intraoperative tumor volume and in less invasive adenomas with Knosp 0-2 additional resection was barely needed. In the case of extensive and invasive adenomas (Knosp 3-4) additional tumor resection and increase in the extent of resection (EoR) has been achieved by using iMRI in both groups.