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Intraoperative MRI in trans-sphenoidal surgery using frameless stereotaxis.

Mitchell Stanton¹, Joyce Antony¹, Teresa Withers¹

¹Department of Neurosurgery, Gold Coast University Hospital, Southport, Queensland, Australia.

Surgical Neurology International

|June 4, 2021

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Frameless stereotaxis combined with intraoperative MRI (iMRI) enhances pituitary surgery safety and efficiency. This approach improves tumor resection and reduces costs, marking a significant advancement in neurosurgical techniques.

Area of Science:

Neurosurgery
Medical Imaging
Surgical Navigation

Background:

Intraoperative magnetic resonance imaging (iMRI) has been utilized in pituitary surgery for two decades.
The advent of frameless stereotaxis has enhanced navigation for both ENT and neurosurgeons.
This technology offers greater flexibility in patient head positioning, optimizing resection and improving operational safety.

Purpose of the Study:

To describe and investigate the application of frameless stereotaxis with iMRI in pituitary surgery.
To evaluate the procedural nuances and impact of this combined technique.

Main Methods:

A retrospective case series of 47 patients undergoing iMRI-guided trans-sphenoidal debulking using frameless stereotaxis.
Data collected from January 2016 to June 2019.

Keywords:

Frameless stereotaxis Intraoperative magnetic resonance imaging Pituitary Trans-sphenoidal

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Utilized the AxiEM (Medtronic, USA) tracker within a "twin-operating" model.

Main Results:

The study included 47 patients with a mean age of 55 years, predominantly female.
Average lesion size was 20 mm, with visual deterioration being the primary surgical indication.
iMRI identified two cases of suboptimal decompression, enabling further resection, and one hemorrhagic complication requiring intervention.

Conclusions:

Frameless stereotaxis with iMRI offers procedural advantages in transsphenoidal surgery.
This technique can reduce patient morbidity and enhance surgical outcomes.
Improved theater utilization and cost reduction are additional benefits.