INTRODUCTION:
Intraoperative MRI (iMRI) has emerged as a beneficial technology to help
achieve maximum outcomes and limit additional surgeries during
transsphenoidal resection of pituitary tumors. Its use has been
documented by many groups and institutions around the world with
positive outcomes related to gross total resection and extent of
resection1,2. IMRI provides high quality images and
increases the rate of optimal resection while reducing
complications3. IMRI has the ability to target
residual tumor during the operation and provide an opportunity for the
surgical team to target additional resectable lesion, thereby optimizing
surgical goals. This minimizes the need for potential future operations
and maximizes operative resources for better quality of overall care.
IMRI is helpful and can be incorporated effectively into the standard
neurosurgical operating room set up and arrangement for transsphenoidal
pituitary tumor resection4.
Previous authors have documented the benefit of iMRI to provide an
expanded view of the surgical field, increased rates of gross total
resection, extent of resection, and decreased amounts of residual
tumor5. It is widely documented that due to the slower
rates of tumor growth seen in many pituitary tumors, iMRI provides a
useful adjunctive measure to achieve gross total resection.
Transsphenoidal pituitary tumor resection can be technically difficult
due to sometimes unpredictable infiltration of the tumor within vital
nearby neurovascular structures, particularly the cavernous sinus. IMRI
can identify remnants of disease that remain in high risk areas.
Intraoperative decisions to leave residual tumor and potentially treat
with adjunctive measures are one of the most useful benefits of iMRI as
the information provided minimizes risk of overly aggressive
manipulation in these high risk areas. The use of iMRI ultimately allows
the surgeon to make present time decisions for the patient’s management
while being safe and efficient 6,7,8.
The use of iMRI for transsphenoidal resection of pituitary tumors in a
community hospital setting has not yet been published in the literature.
Current papers in the literature include iMRI for pituitary tumor
resection being used at an multidisciplinary academically supported
institution9. Looking at how iMRI can be used in a
community hospital setting is important and can add to the growing
literature on iMRI use for pituitary tumor resection because it can
serve as evidence for community hospital centers that would like to
acquire this technology to improve patient outcomes and care.
The specific aim of this study is to report the utility of iMRi use in a
community hospital setting for transsphenoidal pituitary tumor
resection. Data analyzed includes; ability to achieve gross total
resection, frequency of use, postoperative outcomes as well as a
discussion of time requirements and iMRI associated complications.