Does Low Field Intraoperative Magnetic Resonance Improve the results of Endoscopic Pituitary Surgery? Experience of the Implementation of a New Device in a Referral Center.

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Does Low Field Intraoperative Magnetic Resonance Improve the results of Endoscopic Pituitary Surgery? Experience of the Implementation of a New Device in a Referral Center.

World Neurosurg. 2017 Feb 27;:

Authors: García S, Reyes L, Roldán P, Torales J, Halperin I, Hanzu F, Langdon C, Alobid I, Enseñat J

Abstract
OBJECTIVE: To assess the contribution of low field intraoperative magnetic resonance(iMRI) to endoscopic pituitary surgery.
MATERIALS AND METHODS: The authors analyzed a prospective series of patients undergoing endoscopic endonasal surgery for pituitary macroadenomas assisted with a low field iMRI(PoleStarN30™Medtronic,0,15T). Clinical, radiological and surgical variables were analyzed and compared with our fully endoscopic historic cohort operated without iMRI assistance. A bibliographic review about pituitary surgery assisted with iMRI was conducted.
RESULTS: 30 patients (57% female, mean age 55years) were prospectively analyzed. The most frequent tumor subtype was nonfuctioning macroadenoma(50%). The average Knosp grade was 2.3 and mean tumor size was 18mm. Surgical and positioning time were 102 and 47 minutes respectively. Hospital stay and complication rates were similar to our historical cohort for pituitary surgery. Mean follow up was 10 months. Complete resection(CR) was achieved in 83% of patients. 7 patients(23%) benefited from iMRI assistance achieving a CR in their surgeries. All patients except one experienced hormonal activity remission. iMRI sensitivity and specifity was 0,8 and 1 respectively. Though not statistically significant, CR rates were globally 11,5% superior in iMRI series compared with our historical cohort. This difference was independent of cavernous sinus invasiveness grade (CR rate increased 12,5% for Knosp 0-II and 8,1% for Knosp III-IV) .
CONCLUSIONS: Low field iMRI is a useful and safe assistance even in advanced surgical techniques such as endoscopy. Its contribution is limited by the intrinsic features of the tumor. Further randomized studies are required to confirm the cost-effectiveness of iMRI in pituitary surgery.

PMID: 28254595 [PubMed - as supplied by publisher]

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