Application of image guidance in pituitary surgery

Abstract

Background:Surgical treatment of pituitary pathologies has evolved along the years, adding safety and decreasing morbidity related to the procedure. Advances in the field of radiology, coupled with stereotactic technology and computer modeling, have culminated in the contemporary and widespread use of image guidance systems, as we know them today. Image guidance navigation has become a frequently used technology that provides continuous three-dimensional information for the accurate performance of neurosurgical procedures. We present a discussion about the application of image guidance in pituitary surgeries.Methods:Major indications for image guidance neuronavigation application in pituitary surgery are presented and demonstrated with illustrative cases. Limitations of this technology are also presented.Results:Patients presenting a history of previous transsphenoidal surgeries, anatomical variances of the sphenoid sinus, tumors with a close relation to the internal carotid arteries, and extrasellar tumors are the most important indications for image guidance in pituitary surgeries. The high cost of the equipment, increased time of surgery due to setup time, and registration and the need of specific training for the operating room personnel could be pointed as limitations of this technology.Conclusion:Intraoperative image guidance systems provide real-time images, increasing surgical accuracy and enabling safe, minimally invasive interventions. However, the use of intraoperative navigation is not a replacement for surgical experience and a systematic knowledge of regional anatomy. It must be recognized as a tool by which the neurosurgeon can reduce the risk associated with surgical approach and treatment of pituitary pathologies.

Nonfunctioning giant pituitary adenomas: Invasiveness and recurrence

“…The details of this technique have been previously described. [ 6 10 39 ] The transcranial route was reserved for subfrontal, retrosellar, and lateral extensions, as a second procedure, after transsphenoidal approach. All patients received a histopathological diagnosis of pituitary adenomas.…”

Endoscopic ultrasound guided resection of a Cushing’s adenoma invading the medial cavernous sinus wall using the "interdural peeling" technique

“…Guilherme Finger, MD, MSCI, 1 Kyle C. Wu, MD, 1 Jaskaran S. Gosal, MD, MCh, 1 Basit Jawad, MD, 2 Joshua Vignolles-Jeong, BA, 3 Ricardo L. Carrau, MD, 2 and Daniel M. Prevedello, MD 1 Departments of 1 Neurosurgery and 2 Otolaryngology, The Ohio State University Wexner Medical Center, Columbus; and 3 The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio Cushing's adenoma invading the cavernous sinus requires aggressive resection to be cured. MRI is frequently inconclusive for identifying microadenomas, and visualizing the involvement of the medial cavernous sinus is even more challenging.…”

“…We could also see the carotid artery more laterally. [3][4][5] 2:58 Continued Dissection and Adenoma Removal From Posterior Pituitary Gland. We continued our dissection, and we were able to obtain an extracapsular resection of the pituitary adenoma that was located on the left side of the pituitary gland.…”

Neurosurgery in the Past and Future. An Appraisal

“…Image guidance navigation in pituitary surgery provides continuous three-dimensional (3D) information regarding anatomical variations of the sphenoid sinus and relationship of tumors to the internal carotid arteries. 23 However, the equipment is expensive and requires specific training for the operating room personnel. Stereotactic radiosurgery for primary and metastatic lesions, as well as arteriovenous malformations, can be performed using linear accelerators and refined systems for visualization and guidance.…”