SynthesisNeurosurgical review2026
Unlocking surgical precision: intraoperative MRI in endoscopic skull base surgery, a meta-analysis.
Synthesis in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
8 authors.
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Abstract
objectiveIntraoperative 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.
methodsPubMed, 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.
resultsTwenty-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%).
conclusionIntraoperative 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.
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