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Objective <p>Intraoperative magnetic resonance imaging (iMRI) is increasingly used in purely endoscopic endonasal skull base surgery (EESBS) to improve surgical accuracy. Given its high cost and logistical demands, quantifying its clinical utility is essential for evidence-based implementation. This meta-analysis was conducted to evaluate the clinical efficacy of iMRI in purely endoscopic endonasal skull base surgery.</p> Methods <p>PubMed, Scopus, and Web of Science databases were searched in accordance with PRISMA guidelines. The last search was conducted on November 7, 2024. Eligible studies were original research articles reporting outcomes of ≥ 6 patients undergoing purely endoscopic endonasal skull base surgery with iMRI. Studies using microscopic or combined approaches were excluded. Primary outcomes included gross-total resection rates, iMRI-detected residual tumor, and rates of additional resection prompted by intraoperative imaging.</p> Results <p>Twenty-seven studies involving 1,871 patients were included. iMRI increased overall GTR by 19.6% (95% CI, 3.7%-35.5%) and by 18.4% (95% CI, 13.9%-22.8%) in pituitary adenomas. Unexpected residual tumor was detected in 19.7% of cases initially presumed complete, leading to immediate further resection in 32.4% of patients. False-positive rates were negligible, and false-negative rates were low (3.5%).</p> Conclusion <p>Intraoperative MRI significantly improves the extent of resection and intraoperative decision-making in purely endoscopic skull base surgery, particularly for pituitary tumors. However, evidence for rarer pathologies such as craniopharyngiomas and chordomas remains limited. Standardized selection criteria and randomized controlled trials are needed to define optimal use and assess cost-effectiveness.</p>

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Unlocking surgical precision: intraoperative MRI in endoscopic skull base surgery, a meta-analysis

  • 期刊论文

  • 发表日期：

    2026年1月10日

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  • Alperen Sozer,
  • Mustafa Caglar Sahin,
  • Ozan Yavuz Tufek,
  • Furkan Karakas,
  • Gokberk Erol,
  • Boran Urfalı,
  • Muammer Melih Sahin,
  • Emrah Celtikci

摘要

Objective

Intraoperative magnetic resonance imaging (iMRI) is increasingly used in purely endoscopic endonasal skull base surgery (EESBS) to improve surgical accuracy. Given its high cost and logistical demands, quantifying its clinical utility is essential for evidence-based implementation. This meta-analysis was conducted to evaluate the clinical efficacy of iMRI in purely endoscopic endonasal skull base surgery.

Methods

PubMed, Scopus, and Web of Science databases were searched in accordance with PRISMA guidelines. The last search was conducted on November 7, 2024. Eligible studies were original research articles reporting outcomes of ≥ 6 patients undergoing purely endoscopic endonasal skull base surgery with iMRI. Studies using microscopic or combined approaches were excluded. Primary outcomes included gross-total resection rates, iMRI-detected residual tumor, and rates of additional resection prompted by intraoperative imaging.

Results

Twenty-seven studies involving 1,871 patients were included. iMRI increased overall GTR by 19.6% (95% CI, 3.7%-35.5%) and by 18.4% (95% CI, 13.9%-22.8%) in pituitary adenomas. Unexpected residual tumor was detected in 19.7% of cases initially presumed complete, leading to immediate further resection in 32.4% of patients. False-positive rates were negligible, and false-negative rates were low (3.5%).

Conclusion

Intraoperative MRI significantly improves the extent of resection and intraoperative decision-making in purely endoscopic skull base surgery, particularly for pituitary tumors. However, evidence for rarer pathologies such as craniopharyngiomas and chordomas remains limited. Standardized selection criteria and randomized controlled trials are needed to define optimal use and assess cost-effectiveness.