Can intraoperative magnetic resonance imaging be helpful in the surgical resection of parasellar meningiomas ? A Case series.

Abstract Purpose the surgery of parasellar meningiomas is crucial. There are only few reports about the use of intraoperative magnetic resonance imaging (iMRI) for the resection of these lesions. We discuss the safety and utility of this technique in achieving the planned surgical goal and analyze patient´s outcomes. Methods Nineteen cases of parasellar meningioma were treated in our institution using iMRI. We classified the tumors regarding the primary location: tuberculum sellae, clinoidal and cavernous sinus meningiomas. We evaluated the history of previous surgery, outcome, residual (if present) tumor volume, degree of resection, achievement of the surgical goal, number of iMRI scans. Results The preoperative surgical goal was reached in all patients. In 7 on 19 (37%) total cases further tumor resection was performed after the first iMRI scan. Regarding the cavernous sinus group the surgical resection was continued after the first iMRI in 56% of the patients obtaining substantial additional volume reduction. We had no complications related to the use of iMRI scan. Conclusion The iMRI has been effective in safely increasing the extent of parasellar meningioma resection mainly for recurrent and invasive tumors. Its utility has been seen mostly in cavernous sinus lesions where it allowed the further safe resection in 56% of the cases. Moreover, this tool was particularly useful in recurrent or residual meningiomas with extension in extracranial compartments.