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Recent Clinical Article

Combined high-field intraoperative magnetic resonance imaging and endoscopy increase extent of resection and progression-free survival for pituitary adenomas

Pituitary (2015) 18:72–85 DOI 10.1007/s11102-014-0560-2


Peter T. Sylvester
John A. Evans
Gregory J. Zipfel
Richard A. Chole
Ravindra Uppaluri
Bruce H. Haughey
Anne E. Getz
Julie Silverstein
Keith M. Rich
Albert H. Kim
Ralph G. Dacey
Michael R. Chicoine

Purpose: The clinical benefit of combined intraoperative magnetic resonance imaging (iMRI) and endoscopy for transsphenoidal pituitary adenoma resection has not been completely characterized. This study assessed the impact of microscopy, endoscopy, and/or iMRI on progression-free survival, extent of resection status (gross-, near-, and sub- total resection), and operative complications.

Methods: Retrospective analyses were performed on 446 transsphenoidal pituitary adenoma surgeries at a single institution between 1998 and 2012. Multivariate analyses were used to control for baseline characteristics, differences during extent of resection status, and progression- free survival analysis.

Results: Additional surgery was performed after iMRI in 56/156 cases (35.9 %), which led to increased extent of resection status in 15/156 cases (9.6 %). Multivariate ordinal logistic regression revealed no increase in extent of resection status following iMRI or endoscopy alone; however, combining these modalities increased extent of resection status (odds ratio 2.05, 95 % CI 1.21–3.46)