Multimodal Navigation in Endoscopic Transsphenoidal Resection of Pituitary Tumors Using Image-Based Vascular and Cranial Nerve Segmentation: A Prospective Validation Study.
BACKGROUND
Transsphenoidal surgery (TSS) is the most common approach for the treatment of pituitary tumors. However, misdirection, vascular damage, intraoperative cerebrospinal fluid leakage, and optic nerve injuries are all well-known complications, and the risk of adverse events is more likely in less-experienced hands. This prospective study was conducted to validate the accuracy of image-based segmentation coupled with neuronavigation in localizing neurovascular structures during TSS.


METHODS
Twenty-five patients with a pituitary tumor underwent preoperative 3-T magnetic resonance imaging (MRI), and MRI images loaded into the navigation platform were used for segmentation and preoperative planning. After patient registration and subsequent surgical exposure, each segmented neural or vascular element was validated by manual placement of the navigation probe or Doppler probe on or as close as possible to the target.


RESULTS
Preoperative segmentation of the internal carotid artery and cavernous sinus matched with the intraoperative endoscopic and micro-Doppler findings in all cases. Excellent correspondence between image-based segmentation and the endoscopic view was also evident at the surface of the tumor and at the tumor-normal gland interfaces. Image guidance assisted the surgeons in localizing the optic nerve and chiasm in 64% of cases. The mean accuracy of the measurements was 1.20 ± 0.21 mm.


CONCLUSIONS
Image-based preoperative vascular and neural element segmentation, especially with 3-dimensional reconstruction, is highly informative preoperatively and potentially could assist less-experienced neurosurgeons in preventing vascular and neural injury during TSS. In addition, the accuracy found in this study is comparable to previously reported neuronavigation measurements. This preliminary study is encouraging for future prospective intraoperative validation with larger numbers of patients.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: pdolati@bidmc.harvard.edu.
Parviz
P
Dolati
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Daniel
D
Eichberg
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Alexandra
A
Golby
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Amir
A
Zamani
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Edward
E
Laws
D049913:ACTH-Secreting Pituitary Adenoma / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D000236:Adenoma / Q000000981:diagnostic imaging / Q000378:metabolism / Q000601:surgery*; D015901:Angiography, Digital Subtraction; D016080:Arachnoid Cysts / Q000000981:diagnostic imaging / Q000601:surgery*; D001808:Blood Vessels / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D003391:Cranial Nerves / Q000000981:diagnostic imaging; D003884:Dermoid Cyst / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D049912:Growth Hormone-Secreting Pituitary Adenoma / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D038361:Neuronavigation / Q000379:methods*; D047748:Pituitary ACTH Hypersecretion / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013972:Thyrotropin / Q000378:metabolism; D018608:Ultrasonography, Doppler
D013972:Thyrotropin
Internal carotid artery; Magnetic resonance imaging; Navigation; Optic nerve; Pituitary tumor; Segmentation