UTILITY OF INTRAOPERATIVE MRI IN PITUITARYSURGERY- AIIMS EXPERIENCE
Vivek Tandon, Harish Chandrappa, Ashish Suri, P. Sarat Chandra, Shashank Sharad Kale, Ajay Garg, Bhawani Shankar Sharma,Ashok Kumar Mahapatra
Introduction:
Intraoperative MRI (IOMRI) provides 3 dimensional, real time based guidance and helps a surgeon to access the extent of resection during pituitary surgery. We have analyzed 100 consecutively operated patients of pituitary adenomas to know the usefulness of this modality.
Materials and Methods:
We have retrospectively analysed 100 consecutive patients of pituitary adenoma operated in IOMRI guidance. Tumor volumes were calculated using iPlan and Elements software of brainlab. Data was analyzed for demographic profile, extent of resection, hormonal, visual and clinical outcome of patients.
Results:
60 % patients were male, Mean age was 38.7 Years (Range 7-70 Yrs). 67 patients had macroadenomas, while 21 cases were of Giant pituitary adenoma, and 12 had microadenoma. 74%cases were on non-functional pituitary adenoma. 49 % patients had improvement in vision after the surgery. In 35 patients, intraoperative MRI was found to have changed the surgeon’s strategy, as detection of residual tumor led to further attempt
at resection and finally gross total resection could be achieved in 15 of these patients. Thus 85 cases had radiologically proven gross total resection. Residual tumor bleed or SAH was observed in 5/100 cases and post-operative diabetes insipidus was observed in 5 cases.
Conclusions:
IOMRI is very useful in analyzing the extent of resection during surgery
for pituitary adenoma. Intraoperative detection of residual tumor and ability to localize it using neuronavigation helps the surgeon in improving the extent of resection.