Abstract
Background: Neuronavigation is a commonly used technology that provides continuous, three-dimensional
information for the precise localization of and surgical trajectory to brain lesions.
This study was performed to evaluate the role that navigation can play in assisting
microsurgical transsphenoidal surgery for precise localization and removal of recurrent
pituitary tumours while simultaneously preserving pituitary gland function. Method: During a 6-month period - July 2004 until December 2004 - 9 patients with recurrent
pituitary tumours (5 female and 4-male) were treated with navigation-guided transsphenoidal
microsurgical resection. Surgery was performed via a paraseptal or endonasal transsphenoidal
approach. The navigation system Vector Vision (Brain Lab, Heimstetten, Germany) allowed
precise localization of the tumours (7 hormonal active and 2 inactive microadenomas)
in respect to the pituitary gland, the carotid arteries and the cavernous sinus. Results: Postoperative MRI investigations of the 9 patients treated with image-guided transsphenoidal
microsurgery, showed total tumour removal in 7 (77 %) patients and subtotal removal
in 2 patients (23 %). One patient (11 %) developed a cerebral spinal fluid (CSF) leak
and was treated conservatively. One patient (11 %) had preoperative insufficiency
of the corticotrope axis which remained unchanged postoperatively. Of the remaining
8 patients who did not have preoperative endocrinological disturbance, only one (12
%) developed postoperative insufficiency of the corticotrope axis. Out of the 7 patients
with hormone active tumours, 5 (72 %) patients showed no more postoperative hormonal
activity. Conclusion: Microneurosurgical transsphenoidal techniques combined with image-guided systems
can precisely define the localization and removal of lesions in the sella region with
respect to the margins of important anatomical structures in the neighbourhood and
the endocrinological functionality of the pituitary gland.
Key words
Pituitary surgery - neuroendoscopy - neuronavigation - recurrence - transsphenoidal
surgery
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Patra Charalampaki,M. D.
Department of Neurosurgery · Johannes-Gutenberg University Mainz
Langenbeckstr. 1
55101 Mainz
Germany
Phone: +49/6131/177/331
Fax: +49/6131/172/274 ·
Email: charalampaki@yahoo.de
