title: "Intrasellar Balloon Technique" in intraoperative MRI guided transsphenoidal endoscopic surgery for sellar region tumors. Usefulness on image interpretation and extent of resection evaluation. Technical note.
abstract: BACKGROUND
  Intraoperative magnetic resonance imaging (iMRI) is an effective and proven tool in transsphenoidal endoscopic surgery. However, image interpretation is not always easy and can be hindered by the presence of blood, tumor remains or the displacement of surrounding structures. In this article we present a novel technique based on using intrasellar ballons to reduce these difficulties and facilitate the surgeon's intraoperative assessment by iMRI.
  
  
  METHODS
  Eighteen patients with pituitary macroadenomas underwent transsphenoidal surgery during 2013-2014 under low-field iMRI control (PoleStar N20, 0.15 T). Intrasellar balloons were used in all of them to assess the presence of tumoral remnants. We compared the findings in iMRI and postoperative high-field MRI control scans and also analyzed the number of intermediate imaging controls needed during surgery using this technique.
  
  
  RESULTS
  In total, of the 18 patients, 14 underwent a complete resection. In the remaining four patients, a safe maximal resection was performed, leaving a remnant because of cavernous sinus invasion. In all cases, the balloons were a major help in distinguishing the anatomical structures from the tumoral remnants. Fewer imaging controls were required, and there were no false-positives or negative intraoperative findings. No complications related to the technique were registered.
  
  
  CONCLUSIONS
  The "intrasellar balloon technique" is a useful tool that facilitates surgeons' intraoperative decision making. It is an important contribution to overcome the limitations of low-field iMRI as it provides a precise delineation of the resection margins, reduces false-positives and -negatives, and decreases the number of intermediate imaging controls required.
authors.affiliation: Department of Neurosurgery, Clinical University Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Paloma
authors.initials: P
authors.lastname: Jiménez
authors.affiliation: Department of Neurosurgery, Clinical University Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Brell
authors.affiliation: Department of Otorhinolaryngology, Clinical University Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Sarriá-Echegaray
authors.affiliation: Department of Neurosurgery, Clinical University Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Roldán
authors.affiliation: Department of Otorhinolaryngology, Clinical University Hospital Son Espases, Palma de Mallorca, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Tomás-Barberán
authors.affiliation: Department of Neurosurgery, Clinical University Hospital Son Espases, Palma de Mallorca, Spain. j.ibanez.dominguez@telefonica.net.
authors.forename: Javier
authors.initials: J
authors.lastname: Ibáñez
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Balloon technique; Image interpretation; Intraoperative magnetic resonance imaging (iMRI); Pituitary tumors; Resection margin; Transsphenoidal endoscopic surgery