Image-guided navigation in transnasal surgery of pituitary adenomas
Nevronavigacija pri transnazalnih operacijah hipofiznih adenomov

english

2009

volume 14, issue 30

Pituitary Neoplasms   Surgery    Sphenoid Sinusitis   Nasal Cavity    Endoscopy    Middle Age    Sphenoid Bone   Sella Turcica    Adenom   tumor 

Slovensko zdravniško društvo, Združenje za endoskopsko kirurgijo

Background. Endoscopic view inside the sphenoid sinus reveals important bony orientiers that enable maximal trephination of the sellar floor. When the bonywall is thick and irregular, use of image-guided navigation is mandatory. Patients and Methods. This study reports cases of simple and extended pituitary adenomas, where bilateral sphenoidectomy and adenoma removal was performed bimanually and endoscopically through one nostril only or by two nostrils-four hands technique or by combined micro-endoscopic technique. In all cases image-guided navigation was used during tumor removal followed by final endoscopic revision of the operative field. Results. Image-guided navigation proved useful in doubtful cases for identification of midline, carotid protuberance and opto-carotid recess and estimation of bone thicknessover these structures. Especially useful was identification of paraclival carotid artery during the drilling of the invaded bone of subsellarclivus. Conclusion. Image-guided navigation enables safer and maximalexposure of sellar floor which provides maximal visualisation of the intrasellar space. Localisation, direction and bone thickness over different segments of parasellar carotid artery and optic nerve can be checked anytime during the surgery. Angular vision enables removal of minute tumor remnants, that canćt be seen using microscopic technique.

10.02.2010