Multimodal multidisciplinary surgical approach for the treatment of pituitary tumours.
OBJECTIVE
The surgical management of pituitary tumours is being impacted by the development of two key technologies: image guidance and endoscopy. This study sought to assess their impact.


METHODS
Retrospective review of all patients referred to the Skull Base Clinic of the McGill University Health Centre since 2000. Patients were operated on in a multidisciplinary context using a multimodal approach combining endoscopy and microscopy. Imaging during the surgery was initially supported by both three-dimensional neuronavigation and traditional C-arm fluoroscopy.


RESULTS
Seventy-five patients were referred to the multidisciplinary clinic, for a total of 41 surgeries. Neuronavigation was used in all cases. C-arm fluoroscopy was not found to improve our surgeries and was removed from our protocol. Endoscopy was found to be advantageous as it allowed improved visualization. It also permitted identifying surrounding structures in the lateral wall of the sphenoid sinus, next to the tumour, and "around corners." Moreover, it encouraged multidisciplinary co-operation as it allowed neurosurgeons and otolaryngologists to follow progress during the case. Nevertheless, the microscope continued to play a role as it facilitated a bimanual technique, stable magnification, and a three-dimensional view. Morbidities in our case series appeared to be minimal.


CONCLUSIONS
Both endoscopy and the microscope were found to have a role in our surgeries. We consider these technologies to be complementary. C-arm fluoroscopy was rendered obsolete by the neuronavigation unit. A multidisciplinary, multimodal approach maximizes the benefits of these new technologies and permits the best surgical result.
Abou-Jaoude
Peter M
PM
Department of Otolaryngology, McGill University Health Centre, Montreal, QC, Canada.
Zeitouni
Anthony G
AG
Soualmi
Labib
L
Leblanc
Richard
R
D000328:Adult; D000368:Aged; D004724:Endoscopy; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D038361:Neuronavigation; D010911:Pituitary Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome