The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases.
OBJECTIVE
The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood.


METHODS
We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated. In this case, we performed an endonasal transsphenoidal approach for debulking the adenoma and for chiasma decompression. We used an MRI neuronavigation (Medtronic Stealth Air System) which was registered via intraoperative CT scan (Siemens CT Somatom). Preexisting MRI studies (navigation protocol) were fused with the intraoperative CT scans to enable three-dimensional navigation based on MR and CT imaging data. Intraoperatively, we did a further CT scan for resection control.


RESULTS
The intraoperative accuracy of the neuronavigation was excellent. There was an adjustment of <1 mm. The navigation was very helpful for orientation on the destroyed skull base in the sphenoid sinus. After opening the sellar region and tumor debulking, we did a CT scan for resection control because the extent of resection was not credible evaluable in this huge infiltrating adenoma. Thereby, we were able to demonstrate a sufficient decompression of the chiasma and complete resection of the medial part of the adenoma in the intraoperative CT images.


CONCLUSIONS
The use of intraoperative CT/MRI-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique for special cases.
Department of Neurosurgery, Saarland University, Homburg, Germany.
Stefan
S
Linsler
Department of Neurosurgery, Saarland University, Homburg, Germany.
Sebastian
S
Antes
Department of Neurosurgery, Saarland University, Homburg, Germany.
Sebastian
S
Senger
Department of Neurosurgery, Saarland University, Homburg, Germany.
Joachim
J
Oertel
Endoscopic endonasal surgery; intraoperative computed tomography; merged computed tomography-magnetic resonance neuronavigation; pituitary surgery
J Neurosurg. 1993 Mar;78(3):510-4
8433160
Acta Neurochir (Wien). 2001;143(4):327-37
11437285
J Neurosurg. 2009 Dec;111(6):1179-84
19326991
Eur J Radiol. 2007 May;62(2):192-8
17229539
HNO. 1989 May;37(5):187-90
2732101
Neurosurgery. 1996 Jul;39(1):194-202; discussion 202-4
8805161
Neurol India. 2002 Sep;50(3):244-55
12391447
Surg Neurol. 2000 Jun;53(6):563-72; discussion 572
10940424
World Neurosurg. 2013 Dec;80(6):709-16
23851232
Acta Neurochir Suppl. 2011;109 :163-7
20960337
Surg Neurol. 1987 Jun;27(6):543-7
3554569
Minim Invasive Neurosurg. 2005 Feb;48(1):7-12
15747210
Neurosurgery. 2001 Nov;49(5):1133-43; discussion 1143-4
11846908
Neurosurgery. 1993 Jan;32(1):51-7; discussion 57
8421557
J Clin Neurosci. 2001 Jul;8(4):305-10
11437567
J Neurol Surg B Skull Base. 2013 Jun;74(3):146-54
24436905
Otolaryngol Head Neck Surg. 2006 May;134(5):868-76
16647550
Pituitary. 1999 Aug;2(2):155-62
11081166
Pediatr Neurosurg. 1997 Feb;26(2):68-82
9419036
J Neurosurg. 1993 Jul;79(1):36-42
8315467
Childs Nerv Syst. 2006 Sep;22(9):1065-71
16761161
J Neurosurg. 1986 Oct;65(4):545-9
3531430
J Neurosurg Pediatr. 2009 Apr;3(4):325-30
19338413
Minim Invasive Neurosurg. 2005 Feb;48(1):13-8
15747211
Childs Nerv Syst. 2010 Jul;26(7):871-8
20076987
Eur J Radiol. 2010 Feb;73(2):224-9
19097718
Neurol Neurochir Pol. 2012 Nov-Dec;46(6):536-41
23319221
J Neurosurg. 1995 Aug;83(2):197-205
7616261
J Korean Neurosurg Soc. 2013 Mar;53(3):161-6
23634266
Pediatr Neurosurg. 1997 Dec;27(6):319-24
9655147
J Neurosurg. 2001 Sep;95(3):381-90
11565857
Pediatr Neurosurg. 1997 Mar;26(3):127-9
9419029
Zentralbl Neurochir. 2003;64(4):166-70
14634881
Radiologe. 1995 Sep;35(9):573-7
8588038
J Neurosurg. 1991 May;74(5):845-9
2013785
Pediatr Neurosurg. 1999 Nov;31(5):231-6
10681676