Endoscopic Transnasal Approach to the Pituitary Lesions Using a Navigation System (InstaTrak™ System): Technical Note

Abstract

The endoscopic transnasal approach has become a procedure of choice for the surgical management of pituitary lesions. However, in conventional endoscopic transnasal surgery, the surgeon may become disorientated to the actual operating position. In our series, 31 patients have undergone an endoscopic transnasal approach to the pituitary lesions with the use of the navigation system InstaTrak^TM for real-time imaging. This image guidance system proved valuable for anatomic localization during pituitary surgery. We have reduced the average surgical time, and improved patient outcome. As consequence, complications during surgery should decrease and safety should increase. Intraoperative image guidance is expected to have major advantageous effects on pituitary surgery by allowing the surgeon to remove pathology more efficiently. As this system is improved technically and surgeons become more proficient in its use, there should be better postoperative outcomes.

Key words

Endoscopy - Transnasal Approach - Pituitary Lesions - Navigation System

References

• 1 Jankowski R, Auqye J, Simon C, Marchal J C, Hepner H, Wayoff M. Endoscopic pituitary tumor surgery.  Laryngoscope. 1992;  102 198-202
• 2 Jho H D, Carrau R L. Endoscopic endonasal transsphenoidal surgery: experience with 50 patients.  J Neurosurg. 1997;  87 44-51
• 3 Morita A. Endoscopic transnasal transsphenoidal approach to the pituitary lesions: anatomy, basic technique and avoidance of pitfalls.  No Shinkei Geka (in Japanese). 1999;  27 699-710
• 4 Zamorano L J, Nolte L, Kadi A M, Jiang Z. Interactive intraoperative localization using an infrared-based system.  Neurol Res. 1993;  15 290-298
• 5 Fried M P, Kleefield J, Gopal H, Reardon E, Ho B T, Kuhn F A. Image-guided endoscopic surgery: Results of accuracy and performance in a multicenter clinical study using an electromagnetic tracking system.  Laryngoscope. 1997;  107 594-601
• 6 Nasseri S S, McCaffrey T V, Kasperbauer J L, Atkinson J L. A combined, minimally invasive transnasal approach to the sella turcica.  Am J Rhinol. 1998;  12 409-416
• 7 Metson R, Gliklich R E, Cosenza M. A comparison of image guidance systems for sinus surgery.  Laryngoscope. 1998;  108 1164-1170
• 8 Anon J B. Computer-aided endoscopic sinus surgery.  Laryngoscope. 1998;  108 949-961
• 9 Otori N, Haruna S, Yoshikawa M, Moriyama H. Image-guided endoscopic endonasal surgery for paranasal cyst.  Jiten (in Japanese). 1999;  42 283-288