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How to overcome the limitations to determine the resection margin of pituitary tumours with low-field intra-operative MRI during trans-sphenoidal surgery: usefulness of Gadolinium-soaked cotton pledgets

 Ahn JY  ;  Jung JY  ;  Kim J  ;  Lee KS  ;  Kim SH 
 ACTA NEUROCHIRURGICA, Vol.150(8) : 763-771, 2008 
Journal Title
Issue Date
Administration, Topical ; Adolescent ; Adult ; Aged ; Artifacts ; Contrast Media/administration & dosage* ; Endoscopy/methods* ; Female ; Gadolinium DTPA*/administration & dosage ; Humans ; Image Enhancement* ; Image Processing, Computer-Assisted* ; Intraoperative Period ; Magnetic Resonance Imaging* ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neurosurgical Procedures/methods* ; Pituitary Neoplasms/pathology ; Pituitary Neoplasms/surgery* ; Sphenoid Sinus/surgery ; Surgery, Computer-Assisted/methods*
Intra-operative magnetic resonance imaging ; resection margin ; pituitary tumour ; trans-sphenoidal approach
OBJECTIVE: Intra-operative MRI (iMRI) is used as an immediate intra-operative quality control, allowing surgeons to extend resections in situations involving residual tumour remnants. Despite these advantages, low-field iMRI has some limitations with regards to image quality and artefacts. The aim of this study is to report our experience with bone wax and Gadolinium-soaked cotton pledgets in obtaining precise tumour resection margins using low-field iMRI. PATIENTS AND METHODS: The study group included 63 consecutive patients who underwent endonasal trans-sphenoidal surgery with use of intra-operative low-field iMRI (0.15 T, PoleStar N20, Medtronic Navigation, Louisville, CO, U.S.A.). The indications for intra-operative MRI use included a suprasellar or retrosellar extension (n = 23), cavernous sinus invasion (n = 21), a tumour located in the vicinity of critical anatomic structures (such as the internal carotid artery, n = 10), recurrent or revision procedures (n = 5), and pre-operative imaging revealing unusual anatomy (n = 4). RESULTS: Overall, among the 51 patients with intended complete tumour removal, iMRI revealed definite tumour remnants or suspicious findings in 13 patients (25.5%), leading to an extended resection and allowing completion of the resection in 10 patients. There was an increased rate of complete tumour removal from 74.5% (38 out of 51) to 94.1% (48 out of 51). The iMRI scan for complete tumour removal was more efficient in the group receiving Gadolinium-soaked cotton pledgets (85.2-100%) than in the group receiving bone wax or the conventional method (62.5-87.5%). The results of iMRI and the estimation by the surgeon concerning the extent of resection revealed a discrepancy in five patients (15.6%) in the Gadolinium-soaked cotton pledgets application group, and in 14 (45.2%) of the bone wax application group. CONCLUSIONS: More valuable information for determining the resection margin can be obtained with the use of contrast-soaked cottonoid packing in the tumour resection cavity during iMRI scanning. We believe that the use of this simple method reduces the false-positive results and also overcomes the disadvantages of low-field iMRI.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Jinna(김진아) ORCID logo https://orcid.org/0000-0002-9978-4356
Ahn, Jung Yong(안정용)
Lee, Kyu Sung(이규성)
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