| The Additional Role of Neuronavigation in Stereotactic Image-Guided Transsphenoidal Microsugery |
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Dong-Cheon Kim, Joon Cho, Young-Cho Koh, Jae-Hoon Cho, So-Duck Lim, Hong Gee Roh |
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Department of Neurosurgery, Otorhinolaryngology, Pathology, Radiology, Konkuk University College of Medicine, Seoul, Korea |
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| Abstract |
Objective
Stereotactic image guided surgery has been commonly used in brain operations. The continuous and three-dimensional navigation system supported the precise localization and surgical pathway to brain lesions. This study was performed to
review the pituitary adenoma operation to evaluate the role of neuronavigation in transsphenoidal microsurgery.
Method: During a 35 month period from Feb. 2006 to Dec 2008, 27 patients with pituitary tumors including 15 females and 12
males were operated with neuronavigation assisted transsphenoidal microsurgery. The operated pituitary adenomas were functionally active tumors in 13 patients and non-functional tumors in 14 patients. Two registration methods, fiducial registration
method and surface registration method, were used and compared in these 27 patients.
Results
With the two registration methods, 27 sets of accuracy measurements were performed in 27 patients. In comparison
between the fiducial registration method and surface registration method, the initial registration accuracy was 1.55 and 1.82mm,
respectively (geometric means；upper limit of 95% confidence bound was 1.95 and 2.34mm, respectively). Follow-up sella MRI
of the 27 patients showed total tumor removal in 10 (37%) patients, subtotal removal in 13 patients (48%) and partial removal in
4 (15%) patients. 4 patients (15%) experienced cerebral spinal fluid (CSF) leakage and was cured conservatively except 1 patient,
who received dural suture and muscle piece packing. 9 patient (33%) had preoperative visual disturbance, which improved
postoperatively in 7 patients and remained unchanged in 2 patients.
Conclusion
Microsurgical transsphenoidal pituitary tumor resection assisted with neuronavigation system can define regions
of interest in the pituitary fossa area with respect to the critical anatomical structures at risk during operation. |
| Key Words:
Neuronavigation, Transsphenoidal microsurgery, Pituitary adenoma. |
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