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Open Low-Field Intraoperative MRI for Transsphenoidal Pituitary Surgery

Section Editor(s): Saidman, LawrencePandin, Pierre MD; Dewitte, Olivier MD, PhD

doi: 10.1213/01.ane.0000268558.02855.73
Letters to the Editor: Letters & Announcements

Department of Anesthesiology; (Pandin)

Department of Neurosurgery; CUB Erasmus Hospital; Brussels, Belgium (Dewitte)

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To the Editor:

Nemergut et al. (1) recently reviewed perioperative management for transsphenoidal pituitary surgery. However, one ongoing problem is verifying complete removal of the tumor. Studies suggest that complete removal of macroadenoma only occurs approximately 60% (2). To address this, low magnetic field MRI scanners are being developed for intraoperative use (3). These devices permit immediate postoperative MRI imaging of the pituitary, facilitating assessment of whether the tumor was completely excised before awakening the patient from anesthesia (see Fig. 1 below). The MRI can be set up in an existing operating room without special electromagnetic insulation (4). Since installing an MRI in our operating theater two and a half years ago, we have used it in 85 patients. Our incidence of complete surgical removal of pituitary tumors has increased to 90%, which is clearly a benefit to our patients.

Figure 1

Figure 1

Pierre Pandin, MD

Department of Anesthesiology

Olivier Dewitte, MD, PhD

Department of Neurosurgery

CUB Erasmus Hospital

Brussels, Belgium

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1. Nemergut EC, Dumont AS, Barry UT, Laws ER. Perioperative management of patients undergoing transsphenoidal pituitary surgery. Anesth Analg 2005;101:1170–81
2. Mortini P, Losa M, Barzaghi R, Boari N, Giovanelli M. Result of transphenoidal surgery in a large series of patients with pituitary adenoma. Neurosurgery 2005;56: 1222–33
3. Berkenstadt H, Perel A, Ram Z, Feldman Z, Nahtomi-Shick O, Hadani M. Anesthesia for magnetic resonance guided neurosurgery initial experience with a new open magnetic resonance imaging system. J Neurosurg Anesthesiol 2001;13:158–62
4. Levivier M, Wikler D, De Witte O, Van de Steene A, Baleriaux D, Brotchi J. Polestar N-10 low field compact intraoperative magnetic resonance imaging system with mobile radiofrequency shielding. Neurosurgery 2003;53:1001–6
© 2007 International Anesthesia Research Society