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Updated: Jul 13, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Risk of new endocrinological deficits after intraoperative MRI-guided additional resection in endoscopic
Stefanos Voglis1,2, Meltem Gönel1, Maria Triantafyllidou3
1Department of Neurosurgery, Clinical Neuroscience Center, University Hospital, University of Zurich, Zurich, Switzerland.
Objective:
Intraoperative magnetic resonance imaging (ioMRI) has been increasingly used in transsphenoidal surgery for pituitary adenomas to improve the rate of gross total resection (GTR). However, its influence on postoperative pituitary function-particularly the risk of new endocrinological deficits (EDs) due to an additional resection-has not been investigated in detail. This study aimed to evaluate the endocrinological outcomes of ioMRI-guided TSS in patients with nonfunctioning pituitary adenomas (NFPAs), with a focus on the risk of new EDs following ioMRI-guided additional resection.
Methods:
We performed a retrospective cohort analysis of prospectively collected data from 312 patients who underwent endoscopic transsphenoidal surgery with the "chopsticks" technique between July 2013 and July 2022. Of these, 155 patients met the inclusion criteria: histologically confirmed NFPA phenotype and 3-Tesla ioMRI usage. All patients had at least 3 months of endocrinological and MRI follow-up. Hormonal outcomes were reviewed by a dedicated endocrinologist using clinical and biochemical assessments.
Results:
Among the 155 included patients (median age 60 years; 59% male), the ioMRI GTR rate was 35%; this increased to 65% (n = 98) on 3‑month postoperative MRI as a result of ioMRI‑guided additional resection. Overall, additional resection following ioMRI was performed in 46% (n = 71) of cases. New EDs of at least one pituitary axis were observed in 23% (n = 35) of patients at discharge, 25% (n = 38) at first follow-up (6 weeks postoperatively), and 18% (n = 28) at final follow-up in total. Any recovery of preoperative EDs occurred in 9.7%, 31% and 45% respectively. Uni- and multivariate logistic regression analysis showed that neither GTR, tumor volume, residual tumor volume nor additional resection following ioMRI were associated with increased risk of new deficits.
Conclusions:
IoMRI-guided additional resection during TSS for NFPAs can be performed safely without increasing the risk of new EDs. These findings support the utility of ioMRI in maximizing the extent of resection while preserving pituitary function.
