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Updated: Dec 26, 2025
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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
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Optimizing MR imaging for intraoperative image guidance in sellar pathologies.
Alexander Micko1, Arthur Hosmann1, Wolfgang Marik2
1Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1097, Vienna, Austria.
Pituitary
|March 15, 2020
Summary
VIBE MRI sequences offer superior visualization of cavernous sinus structures for pituitary adenoma surgery. This optimized imaging protocol enhances surgical guidance and improves accuracy in identifying tumor invasiveness and pituitary gland position.
Area of Science:
- Neurosurgery
- Radiology
- Medical Imaging
Background:
- Extended endonasal approaches enable surgical access to parasellar tumor extensions.
- Accurate visualization of structures at risk in the cavernous sinus (CS) is crucial for surgical planning.
Purpose of the Study:
- To propose an optimized imaging protocol for surgical guidance in the CS.
- To evaluate MRI sequences for visualizing sellar and parasellar structures.
Main Methods:
- Prospective analysis of 20 pituitary adenoma patients undergoing endoscopic transnasal surgery.
- Comparison of MPRAGE, VIBE, and CISS MRI sequences for visualizing sellar/parasellar structures.
- Assessment of invasiveness and pituitary gland position against intraoperative findings.
Main Results:
- VIBE sequences demonstrated the highest consensus (70%) among investigators for visualizing structures.
- 100% consensus was achieved for Knosp Grade using VIBE sequences.
- Intraoperative invasiveness was correctly identified in 95% of cases with VIBE, significantly higher than MPRAGE (60%) and CISS (55%).
Conclusions:
- VIBE sequences provide the highest consensus with intraoperative findings for invasiveness and pituitary gland position.
- High spatial resolution and fast acquisition make VIBE sequences ideal for neuronavigation.
