title: [Clinical application of neuronavigation in transsphenoidal microsurgery of pituitary adenomas].
abstract: OBJECTIVE
  To summarize the experiences in clinical application of neuronavigation in transsphenoidal microsurgery of specific pituitary adenomas, and to discuss its indications.
  
  
  METHODS
  From January 2006 to December 2010, 138 cases of transsphenoidal microsurgery for specific pituitary adenomas under neuronavigation were reviewed. The indications for neuronavigation in transsphenoidal microsurgery includes: recurrent or regrowth of residual pituitary adenomas after former transsphenoidal surgery in 36 cases, invasive pituitary adenomas in 45 cases, extremely laterally or deeply situated microadenomas in 45 cases, poor pneumatization of the sphenoid in 4 cases, skull base anomalies due to osteodysplasia fibrosa in 3 cases, narrow space between bilateral internal carotid arteries in 4 cases, distortion of nasal septum in 1 case.
  
  
  RESULTS
  In the recurrence group, 12 were totally removed, 9 subtotally removed; postoperative complications included hematoma within the tumor cavity in 2 cases, cerebrospinal fluid (CSF) leakage in 4 cases among which 3 developed intracranial infection and 2 communicating hydrocephalus, oculomotor paralysis in 1 case and hypopituitarism in 3 cases; 9 were cured and 8 remission. In the invasive group, 5 were totally removed, 27 subtotally removed; postoperative complications included hematoma within the tumor cavity in 1 case, CSF leakage and intracranial infection in 1 case; 2 were cured and 22 remission. None of the 30 invasive hormone-secreting adenomas were cured or remission. The 45 cases of hormone-secreting microadenomas were all totally removed, among which 38 were cured. Among the poor sphenoid pneumatization group, total and subtotal tumor removal were achieved in 2 cases respectively with only one cured. In the skull base anomaly group, 2 were totally removed and 1 subtotally removed, with only one cured. For the cases with narrow space between bilateral internal carotid arteries and distortion of nasal septum, all were totally removed and cured.
  
  
  CONCLUSIONS
  Transsphenoidal microsurgery under neuronavigation can be applied for pituitary adenomas in above specific indications. It is an accurate, safe and effective approach for specific pituitary adenomas, which can not only expand the indication of transsphenoidal microsurgery for pituitary adenomas, but also reduce the harmful exposure of X-rays for the operating staff.
authors.affiliation: Department of Neurosurgery, Chinese Academy of Medical Sciences, Beijing , China. xuzhq@tom.com
authors.forename: Zhi-qin
authors.initials: ZQ
authors.lastname: Xu
authors.forename: Chang-bao
authors.initials: CB
authors.lastname: Su
authors.forename: Ren-zhi
authors.initials: RZ
authors.lastname: Wang
authors.forename: Zu-yuan
authors.initials: ZY
authors.lastname: Ren
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.forename: Wen-bin
authors.initials: WB
authors.lastname: Ma
authors.forename: Yong-ning
authors.initials: YN
authors.lastname: Li
authors.forename: Bing
authors.initials: B
authors.lastname: Xing
authors.forename: Wei
authors.initials: W
authors.lastname: Lian
authors.forename: Yong
authors.initials: Y
authors.lastname: Yao
authors.forename: Gui-lin
authors.initials: GL
authors.lastname: Li
authors.forename: Wan-chen
authors.initials: WC
authors.lastname: Dou
mesh_terms: D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation; D010911:Pituitary Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000601:surgery; D055815:Young Adult