gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Neuronavigated transspenoidal surgery for sellar and perisellar lesions

Neuronavigierte transsphenoidale Chirurgie bei sellären und perisellären Prozessen

Meeting Abstract

  • corresponding author U. J. Knappe - Klinik für Neurochirurgie, Dr. Horst Schmidt Klinik, Wiesbaden
  • P. Jochimsen - Klinik für Hals-Nasen-Ohren-Heilkunde, Dr. Horst Schmidt Klinik, Wiesbaden
  • M. Westphal - Klinik für Neurochirurgie, Dr. Horst Schmidt Klinik, Wiesbaden
  • R. Schönmayr - Klinik für Neurochirurgie, Dr. Horst Schmidt Klinik, Wiesbaden

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-07.06

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0202.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Knappe et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

We report on the benefit of cranial CT- or MRI-navigation in a consecutive series of 43 operations performed in 41 individuals undergoing transsphenoidal surgery for sellar or perisellar lesions.

Methods

Several patterns of fiducial placement in patients with sellar or perisellar pathology were evaluated using the Stealth Station (Medtronic Sofamor Danek, Inc.). Registration accuracy was within 3 mm. During transnasal approach bony landmarks were identified and precision of the data was verified for CT- (n=11) or MRI-guided (n=30) neuronavigation.

Results

In 33 of 43 consecutive transsphenoidal operations performed in 41 individuals (mean age 51 yrs, range 25-88 yrs; male/female = 1/1; nonsecreting adenomas 22, acromegaly 5, Cushing`s disease 7, TSH-secreting adenoma 1, prolactinoma 1 (macroadenomas 25, invasive adenomas 11, recurrent adenomas 8), chordomas 2, craniopharyngeoma 1, meningeoma 1, metastasis 1), tumour removal was complete. In one case of recurrent invasive GH- and PRL-secreting adenoma with previous radiation therapy transnasal untethering of the optic nerve was performed. In 11 of the other 13 secreting tumours, endocrinological remission was achieved. In 4 out of 11 invasive adenomas residual tumour remained within the cavernous sinus. Three of these were recurrent adenomas, and tumour reduction prior to radiotherapy was the goal of surgery. In 4 of 8 cases with recurrent adenomas radical tumour excision was planned and achieved. In one patient (age 86 yrs) debulking of a meningeoma and decompression of the optic chiasm was the goal of 2 operations. In one patient with lung cancer transsphenoidal tumor reduction and histological verification of metastasis was realized. With the exception of 3 cases, pituitary function did not deteriorate, no deficit of ocular movement occurred. Preexisting visual impairment improved markedly in 10/13, or moderately in 1/13 patients, was unchanged in one and worsened in another case with postoperative hemorrhage. Best accuracy of navigation in the sellar region was obtained when basal structures like the mastoid processes were included during registration.

Conclusions

Particularly in recurrent and invasive lesions, neuronavigation is a powerful tool to improve resection control and reduce surgical morbidity.