Experimental image-guided endoscopic pituitary surgery: A useful learning model

Gong, Jianping; Mohr, Gérard; Vezina, J L

doi:10.1016/j.jocn.2006.07.004

Cited by 6 publications

(4 citation statements)

References 21 publications

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“…3 Neuronavigation in transsphenoidal surgery has been especially advocated in cases where the anatomy of the sphenoid sinus may be distorted, such as in patients with previous pituitary surgery and abnormal nasal or sphenoid sinus anatomy. 12,13,16 Somewhat surprisingly, in the present study there was no significant association between the accuracy in identification of sella margins and previous transsphenoidal surgery nor for that matter the configuration of the sphenoid sinus (i.e., sellar and presellar types). Intuitively, it may have been expected that the inferior margin of the sella floor would be more difficult for the surgeon to identify in presellar-type sphenoid sinus, due to flattening of the clival-sella margin.…”

Section: Discussioncontrasting

confidence: 72%

“…5,7,12 Navigation may be performed using either computed tomography (CT) or magnetic resonance (MR) images and allows confirmation of the margins of the pituitary fossa and the location of important surrounding structures. 13,14 To date, studies describing the usefulness of neuronavigation in endoscopic pituitary surgery have been generally qualitative in nature. 5,6,15,16 In this report, we attempt to quantitate the accuracy of the surgeon's localization of sella margins during endoscopic transsphenoidal surgery and verify this using a neuronavigational system.…”

mentioning

confidence: 99%

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Accuracy of Surgeon's Estimation of Sella Margins during Endoscopic Surgery for Pituitary Adenomas: Verification Using Neuronavigation

Wang¹,

Thiryayi²,

Ramaswamy³

et al. 2011

Skull Base

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We assessed the accuracy of a surgeon's localization of sella margins during endoscopic transsphenoidal surgery for pituitary adenomas, as verified using a neuronavigational system, and we identify types of pathology in which neuronavigation is of most benefit. We performed a prospective cohort study of 32 consecutive patients undergoing image-guided endoscopic transsphenoidal surgery for pituitary adenomas. We assessed the margin of error in the surgeon's localization of the superior and inferior margins of the sella and the lateral margins as determined by the medial border of left and right carotid arteries, using a magnetic resonance-based neuronavigational system. The overall mean error of localization of sella margins by the surgeon was 4.5 AE 3 mm. Localization of the inferior sella margin was more accurate (3.1 AE 2 mm mean error) compared with localization of the left (4.8 AE 3 mm) or right carotid arteries (4.6 AE 3 mm). Giant adenomas (> 2.5 cm), more invasive adenomas (Hardy grade IV), and those with parasellar extension (Hardy grades D and E) were associated with larger errors in localization of the carotid arteries. There was no significant difference when stratifying for recurrent surgery, nostril of approach, and sella morphology. During endoscopic transsphenoidal surgery, the margin of error in the surgeon's estimation of the sella margins for adenomas less than 2.5 cm located predominantly within the sella is relatively small. The margin of error increases for giant adenomas, with greater invasiveness and parasellar spread, and the use of neuronavigation can be especially useful in such cases.

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Section: Discussioncontrasting

confidence: 72%

mentioning

confidence: 99%

Accuracy of Surgeon's Estimation of Sella Margins during Endoscopic Surgery for Pituitary Adenomas: Verification Using Neuronavigation

Wang¹,

Thiryayi²,

Ramaswamy³

et al. 2011

Skull Base

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“…18 Since then its utilization has grown and has become the standard of care at many skull base centers around the nation given its added safety and accuracy. [4][5][6][7][8] For example, it has been shown that there is a discrepancy between the surgeon's estimation of sella margins without image guidance and the accuracy of frameless stereotaxy-4.5 AE 3mm and 1.3 AE 0.6 mm, respectively. 19,20 A large meta-analysis recently demonstrated that the use of image guidance in selected populations decreases the risk of major and total complications in endoscopic sinus surgery.…”

Section: Discussionmentioning

confidence: 99%

“…3 Most recently, stereotactic technology, or computer-guided surgery, has again transformed pituitary surgery as multiple studies have demonstrated a robust safety profile and lower rate of complications. [4][5][6][7][8] Image guidance has also proved to be economical. Chung et al looked into the Nationwide Inpatient Sample database and noted that image guidance for adult transsphenoidal pituitary resection (TSPR) was associated with a lower rate of cerebrospinal fluid (CSF) rhinorrhea, shorter length of stay (LOS), and lower cost.…”

Section: Introductionmentioning

confidence: 99%

Outcomes in Pediatric Transsphenoidal Pituitary Surgery Stratified by the Use of Image Guidance: An Analysis of the Kids' Inpatient Database from 1997 to 2016

Lovin

Choi

et al. 2020

J Neurol Surg B Skull Base

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Background To evaluate the utilization of image guidance technology for pediatric transsphenoidal pituitary resection (TSPR) and analyze the complication rates, length of stay (LOS), and total cost for such surgeries as function of time and utilization of image guidance. Methods The Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) was queried for all cases of TSPR between 1997 and 2016. Factors extracted included patient demographics, use of image guidance, LOS, total cost, and complications, including panhypopituitarism, diabetes insipidus (DI), cerebrospinal fluid (CSF) rhinorrhea, and cranial nerve (CN) III, IV, and VI palsies. Multivariate logistic regression was utilized to determine the odds ratio of developing panhypopituitarism, DI, CSF rhinorrhea, and CN palsies for image-guided versus nonimage-guided cases. A generalized linear model was used to determine the effect of image guidance on inflation-adjusted total cost and LOS. Results A total of 1,297 cases of TSPR were included in the KID over this time period. The majority were female, Caucasian, and older than 15 years. Utilization of image guidance has rapidly increased since 2006. Complication rates were comparable, but when controlling for other factors, the use of image guidance showed a lower risk of postoperative DI (p = 0.05). The use of image guidance also resulted in a shorter LOS by 2.84 days (p < 0.001) with no associated increase in total cost (p = 0.663). Conclusion The use of imaging guidance for pediatric TSPR has precipitously increased in recent years, as it is cost-effective, decreases LOS, and may lead to lower complication rates, such as DI.

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The Evolution of Image Guidance in Transsphenoidal Pituitary Surgery

Rosseau

2013

World Neurosurgery

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Experimental image-guided endoscopic pituitary surgery: A useful learning model

Cited by 6 publications

References 21 publications

Accuracy of Surgeon's Estimation of Sella Margins during Endoscopic Surgery for Pituitary Adenomas: Verification Using Neuronavigation

Accuracy of Surgeon's Estimation of Sella Margins during Endoscopic Surgery for Pituitary Adenomas: Verification Using Neuronavigation

Outcomes in Pediatric Transsphenoidal Pituitary Surgery Stratified by the Use of Image Guidance: An Analysis of the Kids' Inpatient Database from 1997 to 2016

The Evolution of Image Guidance in Transsphenoidal Pituitary Surgery

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