gms | German Medical Science

Objective: In transsphenoidal pituitary surgery the application of neuronavigation is discussed controversially. Conventional and navigated procedures were comparatively analyzed to evaluate the advantages and drawbacks of this application of navigation.

Methods: 265 microsurgical procedures for pituitary ademomas were performed via a transseptal, transsphenoidal approach. In 114 of these operations Neuronavigation was used for preoperative planning and intraoperative orientation. The remaining 151 operations were performed with intraoperative C-arm fluoroscopy. For both groups preparation times and times from skin incision to wound closure were recorded and compared. In addition technical aspects of the different navigation systems and the opinion of the surgeons regarding the usefulness of navigation were obtained.

Results: Out of 114 navigational procedures 9 were performed with an arm- or pointer-based system, 77 with the MKM-microscope and 28 with other navigated microscopes. The use of neuronavigation significantly (p=0,0001, t-test) prolonged preparation time by adding 18.5 minutes. Mean operation times on the other hand were significantly (p=0,006, t-test) reduced by 15.7 minutes for navigational operations. Use of neuronavigation rendered fluoroscopy unnecessary except in 4 cases. In two of these, navigational localisation was confirmed by intraoperative fluoroscopy. No complications occurred due to the use of neuronavigation in these procedures. The neurosurgeons appreciated navigational support in general whereas the pointer-based systems were found to be too bulky and cumbersome to use. The navigated microscopes with the possibility of data injection into the eyepiece of the surgeon were consistently judged positively. Navigation was judged to be particularly helpful in secondary operations for recurrent lesions, microadenomas, parasellar extension and complex anatomical situations.

Conclusions: The application of neuronavigation for transsphnoidal, microsurgical operations in pituitary lesions is safe and in most cases helpful. There is additional time necessary for system setup which is nearly completely compensated for by a shorter duration of the operation itself. Fluoroscopy was not necessary in navigated procedures, reducing the exposure to radiation for both the patient and the surgeon. Furthermore surgeons reported that dissection was faster and more straightforward with navigational support. Neuronavigation helps in the training for transsphenoidal surgery more quickly and even for experienced surgeons, it can be helpful in operations for recurrencies and microadenomas.