title: Application of low-field intraoperative magnetic resonance imaging in transsphenoidal surgery for pituitary adenomas: technical points to improve the visibility of the tumor resection margin.
abstract: BACKGROUND
  Intraoperative magnetic resonance imaging (iMRI) is proven to be advantageous in transsphenoidal surgery (TSS) for pituitary adenomas. We evaluated the efficacy of low-field iMRI. Also, we described several techniques to enhance the visibility of the tumor resection margin.
  
  
  METHODS
  Two hundred twenty-nine patients who underwent TSS using low-field iMRI were analyzed. iMRI was acquired in cases where the tumor removal was thought to meet the surgical goal after the tumor resection cavity had been packed with contrast-soaked cotton pledgets to improve the visibility of the tumor resection margin. Suspicious remnants were localized and explored using updated iMRI-based semi-real-time navigation. A merging technique was adopted for very small tumors. The final outcome was evaluated using postoperative 3-T diagnostic magnetic resonance imaging (MRI).
  
  
  RESULTS
  Among 198 patients in whom total resection was attempted, total resection seemed to have been achieved in 184 patients based on iMRI findings. However, immediate postoperative MRI revealed remnant tumors in 4 out of 184 patients (false-negative rate, 2.2 %). The other 31 patients underwent intended subtotal resection of the tumors. Overall, in 47 patients (20.5 %), the use of iMRI led to further resection. Those patients benefited from the use of iMRI to achieve the planned extent of tumor resection.
  
  
  CONCLUSIONS
  iMRI maximizes the extent of resection and minimizes the possibility of unexpected tumor remnants in TSS for pituitary adenomas. It is essential to reduce imaging artifacts and enhance the visibility of the tumor resection margin during the use of low-field iMRI.
authors: Department of Neurosurgery, Yonsei Brain Research Institute, Pituitary Tumor Clinic, Yonsei University College of Medicine, 250 Seongsanno, Seodaemoon-gu, Seoul, 120-752, Republic of Korea.
authors: Eui Hyun
authors: EH
authors: Kim
authors: Min Chul
authors: MC
authors: Oh
authors: Sun Ho
authors: SH
authors: Kim
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000601:surgery*; D038361:Neuronavigation / Q000379:methods*; D047748:Pituitary ACTH Hypersecretion / Q000175:diagnosis / Q000601:surgery; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000601:surgery*; D012086:Reoperation; D013100:Sphenoid Bone / Q000601:surgery*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA