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DOI: 10.1055/s-0031-1275635
© Thieme Medical Publishers
Accuracy of Surgeon's Estimation of Sella Margins during Endoscopic Surgery for Pituitary Adenomas: Verification Using Neuronavigation
Publication History
Publication Date:
30 March 2011 (online)
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ABSTRACT
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 ± 3 mm. Localization of the inferior sella margin was more accurate (3.1 ± 2 mm mean error) compared with localization of the left (4.8 ± 3 mm) or right carotid arteries (4.6 ± 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.
KEYWORDS
Endoscopic transsphenoidal - pituitary adenomas - neuronavigation
REFERENCES
- 1 Jane Jr J A, Han J, Prevedello D M, Jagannathan J, Dumont A S, Laws Jr E R. Perspectives on endoscopic transsphenoidal surgery. Neurosurg Focus. 2005; 19 E2
- 2 de Divitiis E, Cavallo L M, Cappabianca P, Esposito F. Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors: Part 2. Neurosurgery. 2007; 60 46-58 discussion 58-59
- 3 Jane Jr J A, Thapar K, Kaptain G J, Maartens N, Laws Jr E R. Pituitary surgery: transsphenoidal approach. Neurosurgery. 2002; 51 435-442 discussion 442-444
- 4 Cappabianca P, Cavallo L M, Esposito F, Valente V, De Divitiis E. Sellar repair in endoscopic endonasal transsphenoidal surgery: results of 170 cases. Neurosurgery. 2002; 51 1365-1371 discussion 1371-1372
- 5 Otori N, Haruna S, Kamio M, Ohashi G, Moriyama H. Endoscopic transethmosphenoidal approach for pituitary tumors with image guidance. Am J Rhinol. 2001; 15 381-386
- 6 Ohhashi G, Kamio M, Abe T, Otori N, Haruna S. Endoscopic transnasal approach to the pituitary lesions using a navigation system (InstaTrak system): technical note. Minim Invasive Neurosurg. 2002; 45 120-123
- 7 Jagannathan J, Prevedello D M, Ayer V S, Dumont A S, Jane Jr J A, Laws E R. Computer-assisted frameless stereotaxy in transsphenoidal surgery at a single institution: review of 176 cases. Neurosurg Focus. 2006; 20 E9
- 8 Cappabianca P, Cavallo L M, Esposito F, De Divitiis O, Messina A, De Divitiis E. Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery. Adv Tech Stand Neurosurg. 2008; 33 151-199
- 9 Aydin S, Cavallo L M, Messina A et al.. The endoscopic endonasal trans-sphenoidal approach to the sellar and suprasellar area. Anatomic study. J Neurosurg Sci. 2007; 51 129-138
- 10 Gandhi C D, Christiano L D, Eloy J A, Prestigiacomo C J, Post K D. The historical evolution of transsphenoidal surgery: facilitation by technological advances. Neurosurg Focus. 2009; 27 E8
- 11 Willems P W, van der Sprenkel J W, Tulleken C A, Viergever M A, Taphoorn M J. Neuronavigation and surgery of intracerebral tumours. J Neurol. 2006; 253 1123-1136
- 12 Jane Jr J A, Thapar K, Alden T D, Laws Jr E R. Fluoroscopic frameless stereotaxy for transsphenoidal surgery. Neurosurgery. 2001; 48 1302-1307 discussion 1307-1308
- 13 Gong J, Mohr G, Vézina J L. Experimental image-guided endoscopic pituitary surgery: a useful learning model. J Clin Neurosci. 2007; 14 758-763
- 14 Gong J, Mohr G, Vézina J L. Endoscopic pituitary surgery with and without image guidance: an experimental comparison. Surg Neurol. 2007; 67 572-578 discussion 578
- 15 Durr D G, Sade B, Mohr G. Endoscope-assisted image-guided approach to the pituitary gland: preliminary cadaveric study. J Otolaryngol. 2005; 34 93-98
- 16 Lasio G, Ferroli P, Felisati G, Broggi G. Image-guided endoscopic transnasal removal of recurrent pituitary adenomas. Neurosurgery. 2002; 51 132-136 discussion 136-137
- 17 Bigos S T, Somma M, Rasio E et al.. Cushing's disease: management by transsphenoidal pituitary microsurgery. J Clin Endocrinol Metab. 1980; 50 348-354
- 18 Leach P, Abou-Zeid A H, Kearney T, Davis J, Trainer P J, Gnanalingham K K. Endoscopic transsphenoidal pituitary surgery: evidence of an operative learning curve. Neurosurgery. 2010; 67 1205-1212
- 19 van Lindert E J, Ingels K, Mylanus E, Grotenhuis J A. Variations of endonasal anatomy: relevance for the endoscopic endonasal transsphenoidal approach. Acta Neurochir (Wien). 2010; 152 1015-1020
- 20 Fried M P, Kleefield J, Jolesz F A et al.. Intraoperative image guidance during endoscopic sinus surgery. Am J Rhinol. 1996; 10 337-342
- 21 Gumprecht H K, Widenka D C, Lumenta C B. BrainLab VectorVision Neuronavigation System: technology and clinical experiences in 131 cases. Neurosurgery. 1999; 44 97-104 discussion 104-105
- 22 Dorward N L, Alberti O, Palmer J D, Kitchen N D, Thomas D G. Accuracy of true frameless stereotaxy: in vivo measurement and laboratory phantom studies. Technical note. J Neurosurg. 1999; 90 160-168
- 23 Solheim O, Selbekk T, Løvstakken L et al.. Intrasellar ultrasound in transsphenoidal surgery: a novel technique. Neurosurgery. 2010; 66 173-185 discussion 185-186
- 24 Dusick J R, Esposito F, Malkasian D, Kelly D F. Avoidance of carotid artery injuries in transsphenoidal surgery with the Doppler probe and micro-hook blades. Neurosurgery. 2007; 60 (4 Suppl 2) 322-328 discussion 328-329
Yi Yuen WangM.D.
Department of Neurosurgery, Greater Manchester Neuroscience Centre
Salford Royal Foundation Trust Hospital, Salford, UK M6 8HD
Email: yiyuen.wang@svhm.org.au