title: Sublabial, transseptal, transsphenoidal approach to the pituitary region guided by the ACUSTAR I system.
abstract: OBJECTIVE
  Advances in imaging resolution have resulted in superior visualization of intracranial anatomy. Because of the inherent complexity of the surgical exposure of these lesions, intraoperative localizing techniques are required. Currently, C-arm fluoroscopy provides only two-dimensional localization for these anatomic structures. The recently described ACUSTAR I system, developed in conjunction with Codman and Shurtleff, Inc. (Randolph, Mass.), is an interactive, image-guided device that allows three-dimensional localization with a degree of accuracy previously unattainable. We assessed the clinical utility of the ACUSTAR I system for intraoperative spatial confirmation during transsphenoidal approaches to pituitary lesions.
  
  
  METHODS
  Eight patients underwent transsphenoidal approaches to pituitary lesions with the assistance of the ACUSTAR I system. The spatial relationships were clinically judged intraoperatively by the surgeon and by use of traditional C-arm fluoroscopy and then were compared with the ACUSTAR I system results.
  
  
  RESULTS
  In all eight patients, the ACUSTAR I system correctly displayed the surgical orientation and provided localization to within less than 1 mm. In two patients, this facilitated the redirection of an errant approach. No complications were associated with the use of this image-guided device.
  
  
  CONCLUSIONS
  The ACUSTAR I system is useful in displaying accurate, three-dimensional anatomic relationships during transsphenoidal approaches to pituitary lesions. This system provides critical information intraoperatively to redirect errant approaches and prevent significant morbidity.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2559, USA.
authors.forename: B B
authors.initials: BB
authors.lastname: Burkey
authors.forename: M T
authors.initials: MT
authors.lastname: Speyer
authors.forename: R J
authors.initials: RJ
authors.lastname: Maciunas
authors.forename: J M
authors.initials: JM
authors.lastname: Fitzpatrick
authors.forename: R L
authors.initials: RL
authors.lastname: Galloway
authors.forename: G S
authors.initials: GS
authors.lastname: Allen
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000328:Adult; D003397:Craniopharyngioma / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008046:Lip / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009300:Nasal Septum / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000601:surgery*; D015175:Prolactinoma / Q000601:surgery*; D013100:Sphenoid Bone / Q000601:surgery*