Endoscopic Endonasal Transsphenoidal Surgery for Pituitary Lesions under Intraoperative MRI

Objective: The two most recent significant advances in pituitary surgery have been the endonasal endoscopic approach and intraoperative magnetic resonance imaging.

Aim: The aim of the study is to discuss the impacts of combining the two techniques in pituitary surgery, especially the extent of tumor resection and the complications incidence.

Patients and Methods: Twenty-five patients with pituitary lesion have been operated on using the endonasal endoscopic approach guided by intraoperative MRI (iMRI) in our center. Twelve patients had nonfunctioning pituitary adenomas, six with acromegaly, four had prolactinoma, two had craniopharyngioma, and one patient had Cushing's disease. Preoperative and iMRI images were obtained in all cases.

Results: In 10 patients, iMRI demonstrated the presence of residual tumor, which was resected endoscopically before the completion of surgery helping to achieve a total or near-total excision of the lesion. In two other cases, potential residual tumor was examined endoscopically and found to have normal postoperative change. Total or near-total excision was achieved in 22 patients (88%), and in 3 patients, subtotal excision was done. Five patients had CSF rhinorrhea postoperatively, which was managed conservatively by nasal packing and lumbar drain. No major intraoperative complications were encountered in our series.

Conclusions: Combining iMRI with endoscopic transsphenoidal surgery for pituitary lesion is feasible and increases the safety of the procedure. Each technology provides complementary information, which can assist the surgeon in safely maximizing the extent of tumor resection.