Ultrasonography Imaging during Nasal Endoscopic Transsphenoidal Surgery

Ota, Yasushi; Ishikawa, Mami

doi:10.1159/000346931

Cited by 12 publications

(5 citation statements)

References 17 publications

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“…The use of iUSG has permitted the detection of tumor residuals and the identification of large critical structures, including the carotid arteries. 2,23,32 However, iUSG failed to reliably detect MR-invisible microadenomas in CD patients due to limited resolution, limited directionality, small FOV size, and artifacts. 8 Recently, iMRI in association with TSS has been reported.…”

Section: Discussionmentioning

confidence: 99%

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery

Chittiboina

Talagala²,

Merkle

et al. 2016

JNS

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OBJECTIVE Pituitary MR imaging fails to detect over 50% of microadenomas in Cushing’s disease and nearly 80% of cases of dural microinvasion. Surface coils can generate exceptionally high-resolution images of the immediately adjacent tissues. To improve imaging of the pituitary gland, a receive-only surface coil that can be placed within the sphenoid sinus (the endosphenoidal coil [ESC]) during transsphenoidal surgery (TSS) was developed and assessed. METHODS Five cadaver heads were used for preclinical testing of the ESC. The ESC (a double-turn, 12-mm-diameter surface coil made from 1-mm-diameter copper wire) was developed to obtain images in a 1.5-T MR scanner. The ESC was placed (via a standard sublabial TSS approach) on the anterior sella face. Clinical MR scans were obtained using the 8-channel head coil and ESC as the receiver coils. Using the ESC, ultra–high-resolution, 3D, balanced fast field echo (BFFE) and T1-weighted imaging were performed at resolutions of 0.25 × 0.25 × 0.50 mm3 and 0.15 × 0.15 × 0.30 mm3, respectively. RESULTS Region-of-interest analysis indicated a 10-fold increase in the signal-to-noise ratio (SNR) of the pituitary when using the ESC compared with the 8-channel head coil. ESC-related improvements (p < 0.01) in the SNR were inversely proportional to the distance from the ESC tip to the anterior pituitary gland surface. High-resolution BFFE MR imaging obtained using ESC revealed a number of anatomical features critical to pituitary surgery that were not visible on 8-channel MR imaging, including the pituitary capsule, the intercavernous sinus, and microcalcifications in the pars intermedia. These ESC imaging findings were confirmed by the pathological correlation with whole-mount pituitary sections. CONCLUSIONS ESC can significantly improve SNR in the sellar region intraoperatively using current 1.5-T MR imaging platforms. Improvement in SNR can provide images of the sella and surrounding structures with unprecedented resolution. Clinical use of this ESC may allow for MR imaging detection of previously occult pituitary adenomas and identify microscopic invasion of the dura or cavernous sinus.

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Section: Discussionmentioning

confidence: 99%

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery

Chittiboina

Talagala²,

Merkle

et al. 2016

JNS

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“…13 These stereotaxic techniques, however, are not useful for monitoring extent of resection (resection control) of pituitary macroadenomas. Intraoperative ultrasonography (iUSG), either by trans-cranial 15,16 or trans-sellar 17–19 routes provides imaging of sellar/supra-sellar contents in real time. Investigators have used iUSG to detect tumor residuals and critical structures like the carotid arteries.…”

Section: Imri For Tssmentioning

confidence: 99%

“…Investigators have used iUSG to detect tumor residuals and critical structures like the carotid arteries. 17–19 In addition, iUSG has had some success in detecting microadenomas. 20,21 In patients with Cushing’s disease with negative pre-operative imaging, iUSG detected up to 69% of micro-adenomas.…”

Section: Imri For Tssmentioning

confidence: 99%

iMRI During Transsphenoidal Surgery

Chittiboina

2017

Neurosurgery Clinics of North America

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Surgeons routinely use adjunct imaging tools during transsphenoidal surgery (TSS). Intra-operative MRI (iMRI) was quickly adopted as a surgical adjunct for TSS. Currently, a variety of iMRI systems are in use during TSS. The variations in iMRI systems include field strengths (0.15 to 3 T), magnet configurations (open, retractable, double doughnut etc.) and room configurations. Most studies report that the primary utility of iMRI during TSS lies in detecting resectable tumor residuals following maximal resection with conventional technique. Additionally, stereotaxis, neuronavigation and complication avoidance/detection are enhanced by iMRI use during TSS. The use of iMRI during TSS can lead to increased extent of resection for large tumors. Additionally, improved remission rates from hormone secreting tumors have also been reported with iMRI use. Despite increased surgical duration with iMRI, the incidence of surgical or peri-operative complications are comparable with conventional TSS. In this chapter, the history, indications and future directions for iMRI during TSS are discussed.

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“…Intraoperative ultrasound was reported as an adjunct for pituitary surgery. 1-5 However, adoption has been limited by probe bulk, inadequate resolution, and lack of commercially available endonasal probes. 6-9…”

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confidence: 99%

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confidence: 99%

Endoscopic Endonasal Resection of Clival Chordoma Assisted by a Novel Minimally Invasive Ultrasound Technology: 2-Dimensional Operative Video

Zachariah

Robbins

Geisler

et al. 2022

Operative Neurosurgery

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Intraoperative ultrasound was reported as an adjunct for pituitary surgery. [1][2][3][4][5] However, adoption has been limited by probe bulk, inadequate resolution, and lack of commercially available endonasal probes. [6][7][8][9] We report the first time use of a minimally invasive ultrasound probe that is easily positioned endonasally, acquires high-resolution shallow depth imagery, and will soon be commercially available as an accessory for a neurosurgical ultrasound widely used in the United States. We additionally report the first time use of this probe in the posterior fossa. We believe that this probe will facilitate ultrasound use in pituitary and expanded endonasal surgery. This procedure was performed with the patient's consent.

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Ultrasonography Imaging during Nasal Endoscopic Transsphenoidal Surgery

Cited by 12 publications

References 17 publications

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery

Endosphenoidal coil for intraoperative magnetic resonance imaging of the pituitary gland during transsphenoidal surgery

iMRI During Transsphenoidal Surgery

Endoscopic Endonasal Resection of Clival Chordoma Assisted by a Novel Minimally Invasive Ultrasound Technology: 2-Dimensional Operative Video

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