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Updated: Jun 16, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Suprasellar Anterior-Posterior Diameter Optimizes the Use of Intraoperative MRI in Patients Undergoing Endoscopic
Cathal John Hannan1, Christina Daousi2, Mark Radon3
1Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool , UK.
Background And Objectives:
Intraoperative MRI (iMRI) has been demonstrated to improve the extent of resection of pituitary neuroendocrine tumors resected using endoscopic endonasal approaches. We sought to establish if preoperative clinicoradiological parameters could be used to predict which patients are most likely to benefit from iMRI and thus allow more efficient use of this technology.
Methods:
A prospectively maintained surgical database of all endoscopic pituitary tumor resections with iMRI guidance performed between May 2017 and September 2023 was accessed. Data were collected on clinical and radiological parameters that may predict reintervention after iMRI. Logistic regression models were constructed to assess the relationship between predictor variables and reintervention after iMRI.
Results:
Seventy-three patients were included in the study. After review of the iMRI, 24/73 (33%) patients underwent surgical reintervention. The combined rate of gross total resection/near total resection was 64/73 (88%). The rate of biochemical cure of endocrine disease after surgery for a hormonally active tumor was 15/21 (71%). On univariate logistic regression analysis, the only factor significantly associated with reintervention after iMRI was the suprasellar anterior-posterior diameter (odds ratio 1.1, 95% CI 1.01-1.2, P = .030).
Conclusion:
Suprasellar anterior-posterior diameter ≥15 mm predicts the requirement for reintervention after endoscopic resection of pituitary neuroendocrine tumor. Use of this easily obtained radiological parameter will allow iMRI to be used in those patients who are most likely to benefit.
Insights
Preoperative suprasellar anterior-posterior diameter can predict reintervention after pituitary tumor surgery. Measuring this diameter helps identify patients who will benefit most from intraoperative MRI (iMRI) during endoscopic endonasal approaches.
Area of Science:
- Neurosurgery
- Endocrinology
- Radiology
Background:
- Intraoperative MRI (iMRI) enhances tumor resection extent in pituitary neuroendocrine tumors (PitNETs) via endoscopic endonasal approaches.
- Predictive preoperative factors for iMRI benefit remain underexplored.
Purpose of the Study:
- To identify preoperative clinicoradiological parameters predicting patient benefit from iMRI.
- To optimize the efficient utilization of iMRI technology in PitNET surgery.
Main Methods:
- Prospective database analysis of endoscopic PitNET resections with iMRI guidance (May 2017-September 2023).
- Logistic regression modeling to assess predictors of reintervention post-iMRI.
- Data collection on clinical and radiological parameters.
Main Results:
- Seventy-three patients were analyzed; 33% required reintervention after iMRI review.
- Gross total/near total resection achieved in 88% of patients.
- Suprasellar anterior-posterior diameter (≥15 mm) was the sole significant predictor of reintervention (OR 1.1, P=.030).
Conclusions:
- A suprasellar anterior-posterior diameter ≥15 mm predicts the need for reintervention following endoscopic PitNET resection.
- This parameter enables targeted iMRI application to patients most likely to benefit, improving resource allocation.
