Jiménez Paloma, Brell Marta, Sarriá-Echegaray Pedro, Roldán Pedro, Tomás-Barberán Manuel, Ibáñez Javier
Department of Neurosurgery, Clinical University Hospital Son Espases, Palma de Mallorca, Spain.
Department of Otorhinolaryngology, Clinical University Hospital Son Espases, Palma de Mallorca, Spain.
Acta Neurochir (Wien). 2016 Mar;158(3):445-9. doi: 10.1007/s00701-015-2697-9. Epub 2016 Jan 9.
Intraoperative magnetic resonance imaging (iMRI) is an effective and proven tool in transsphenoidal endoscopic surgery. However, image interpretation is not always easy and can be hindered by the presence of blood, tumor remains or the displacement of surrounding structures. In this article we present a novel technique based on using intrasellar ballons to reduce these difficulties and facilitate the surgeon's intraoperative assessment by iMRI.
Eighteen patients with pituitary macroadenomas underwent transsphenoidal surgery during 2013-2014 under low-field iMRI control (PoleStar N20, 0.15 T). Intrasellar balloons were used in all of them to assess the presence of tumoral remnants. We compared the findings in iMRI and postoperative high-field MRI control scans and also analyzed the number of intermediate imaging controls needed during surgery using this technique.
In total, of the 18 patients, 14 underwent a complete resection. In the remaining four patients, a safe maximal resection was performed, leaving a remnant because of cavernous sinus invasion. In all cases, the balloons were a major help in distinguishing the anatomical structures from the tumoral remnants. Fewer imaging controls were required, and there were no false-positives or negative intraoperative findings. No complications related to the technique were registered.
The "intrasellar balloon technique" is a useful tool that facilitates surgeons' intraoperative decision making. It is an important contribution to overcome the limitations of low-field iMRI as it provides a precise delineation of the resection margins, reduces false-positives and -negatives, and decreases the number of intermediate imaging controls required.
术中磁共振成像（iMRI）是经蝶窦内镜手术中一种有效且已得到验证的工具。然而，图像解读并非总是容易的，血液、肿瘤残留或周围结构的移位可能会妨碍解读。在本文中，我们介绍一种基于使用鞍内球囊的新技术，以减少这些困难，并通过iMRI促进外科医生的术中评估。
2013年至2014年期间，18例垂体大腺瘤患者在低场iMRI（PoleStar N20，0.15 T）控制下接受了经蝶窦手术。所有患者均使用鞍内球囊来评估肿瘤残留情况。我们比较了iMRI和术后高场MRI对照扫描的结果，并分析了使用该技术手术期间所需的中间成像对照次数。
18例患者中，共有14例实现了完全切除。其余4例患者进行了安全的最大程度切除，由于海绵窦侵犯而残留部分肿瘤。在所有病例中，球囊对于区分解剖结构和肿瘤残留起到了很大帮助。所需的成像对照较少，且术中没有假阳性或假阴性结果。未记录到与该技术相关的并发症。
“鞍内球囊技术”是一种有助于外科医生术中决策的有用工具。它对克服低场iMRI的局限性具有重要意义，因为它能精确勾勒切除边缘，减少假阳性和假阴性，并减少所需的中间成像对照次数。
