Author/Editor     Bošnjak, Roman; Benedičič, Mitja; Boršoš, Imre; Urbančič, Jure
Title     Image-guided navigation in transnasal surgery of pituitary adenomas
Translated title     Nevronavigacija pri transnazalnih operacijah hipofiznih adenomov
Type     članek
Source     Endoskopska revija
Vol. and No.     Letnik 14, št. 30
Publication year     2009
Volume     str. 11-5
Language     eng
Abstract     Background. Endoscopic view inside the sphenoid sinus reveals important bony orientiers that enable maximal trephination of the sellar floor. When the bony wall 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 thickness over these structures. Especially useful was identification of paraclival carotid artery during the drilling of the invaded bone of subsellar clivus. Conclusion. Image-guided navigation enables safer and maximal exposure 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 can’t be seen using microscopic technique.
Descriptors     PITUITARY NEOPLASMS
ADENOMA
SPHENOID SINUSITIS
NASAL CAVITY
ENDOSCOPY
MIDDLE AGE
SPHENOID BONE
SELLA TURCICA