Image-Guided Endonasal Transsphenoidal Microsurgical Treatment of Recurrent Microadenomas of the Pituitary Gland

Charalampaki, Patra; Reisch, Róbert; Ayad, Adel; Welschehold, Stefan; Conrad, Jens; Wüster, Christian

doi:10.1055/s-2006-932170

Cited by 13 publications

(8 citation statements)

References 6 publications

(8 reference statements)

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“…Today, the use of IGNS is commonplace in neurosurgery, as it is extremely useful as both a pre-surgical and intraoperative device that improves accuracy in defining anatomical structures. [235810]…”

Section: Discussionmentioning

confidence: 99%

“…Although transsphenoidal surgery can be performed easily and without significant risk of complications in most patients, resection of even limited tumors may be challenging when adjacent anatomical landmarks are absent or obscured. [3]…”

Section: Indicationsmentioning

confidence: 99%

“…[9] Accordingly, patients presenting with tumors closely related to the ICA should routinely be treated with the assistance of IGNS, as the technology not only assists in localization in the sagittal plane (to identify the midline), but also allows the surgeon to localize the ICAs and safeguard against inadvertent injury[3] [Figure 4]. …”

Section: Indicationsmentioning

confidence: 99%

“…[316] Image guidance in pituitary surgery began with the use of intraoperative air encephalography, whereby surgeons performed a lumbar puncture and injected air into the subarachnoid space in order to create contrast around pituitary tumors on intraoperative X-rays. This was particularly useful for tumors with suprasellar extension.…”

Section: Introductionmentioning

confidence: 99%

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Application of image guidance in pituitary surgery

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Dm³

et al. 2012

Surg Neurol Int

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Indicationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Application of image guidance in pituitary surgery

Lf²,

Dm³

et al. 2012

Surg Neurol Int

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“…Neuronavigation systems, which by reconstruction of isovoxel image data provide the surgeon with multiplanar views for preoperative planning and intraoperative orientation, have found wide acceptance for use in endoscopic transsphenoidal surgery [10][11][12][13][14][15][16][17][18][19][20], especially for EEA. However, MPRAGE sequences only provide limited visualization detail of the adenoma extensions into and their relation to the neurovascular structures within the CS.…”

Section: Introductionmentioning

confidence: 99%

Optimizing MR imaging for intraoperative image guidance in sellar pathologies

et al. 2020

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Purpose With the advancement of extended endonasal approaches, the ability to surgically reach parasellar tumor extensions increase. The aim of the study was to propose an optimized imaging protocol for surgical guidance in the cavernous sinus (CS) for proper visualization structures at risk. Methods Prospective case control analysis of 20 consecutive pituitary adenoma patients scheduled for endoscopic transnasal surgery. Assessment of the capability of three different MRI sequences (MPRAGE, VIBE, CISS) by 4 investigators to correctly visualize sellar and parasellar structures. Invasiveness and position of the normal pituitary gland were compared with the intraoperative findings. Results The consensus between the 4 examiners to achieve the same results for all modalities was 40% for MPRAGE, 70% for VIBE and 60% for CISS sequences (p = 0.155). A consensus of Knosp Grade per patient was 80% for MPRAGE, 100% for VIBE and 90% for CISS (overall kappa 0.60). A higher Knosp Grade was found in MPRAGE sequences compared to the other sequences. Intraoperative status of invasiveness was correctly identified in 12/20 (60%) with MPRAGE, 19/20 (95%) with VIBE and 11/20 (55%) with CISS sequences. The position of the normal pituitary gland was most frequent evaluable in 15/20 (75%) and correctly identified in 12/15 (80%) cases. Conclusion Our data showed that VIBE sequences obtain the highest degree of consensus with intraoperative findings of invasiveness and position of the normal pituitary gland. VIBE sequences, due to their high spatial resolution and at the same time fast image acquisition could provide improved imaging for neuronavigation.

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