gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

The role of intraoperative neuronavigation in the endoscopic transsphenoidal surgery of recurrent pituitary adenomas

Navigationgestütze endoskopische transsphenoidale Resektion von Rezidiv- oder Restadenomen der Hypophyse

Meeting Abstract

  • corresponding author R. Reisch - Neurochirurgische Universitätsklinik Mainz
  • C. Charalampaki - Neurochirurgische Universitätsklinik Mainz
  • A. Ayyad - Neurochirurgische Universitätsklinik Mainz
  • A. Perneczky - Neurochirurgische Universitätsklinik Mainz

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.02.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 11. April 2007

© 2007 Reisch et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: To describe the importance of intraoperative neuronavigation in the endoscopic transsphenoidal treatment of recurrent or residual pituitary adnomas.

Methods: During a 30 months period up to May 2006, we have performed 121 pure endoscopic procedures using an endonasal transsphenoidal approach. According to our biportal technique, the sphenoid sinus was exposed through both nostrils, without using a nasal retractor. Of the 121 patients, 23 had recurrent or residual pituitary adenomas, 20 patients were operated previously with standard microsurgical techniques. There were 10 hormonally inactive tumors, 7 STH-adenomas, 5 ACTH-adenomas and 1 prolactinoma. In 7 cases the tumor showed marked supra- or parasellar extension with compression of the chiasm and/or infiltration into the cavernous sinus (Knosp-grade III-IV). For adequate intraoperative orientation, a BrainLAB navigation device was used in every case.

Results: The endoscope allowed exquisite intraoperative visualization with increased light intensity in the deep-seated surgical field. However, whenever the previously performed transsphenoidal approach led to marked scarring of the sellar floor, anatomical orientation was complicated in 17 cases. In these cases, the intraoprative application of the BrainLAB navigation device was particularly useful in avoiding severe disorientation. There were no severe intraoperative complications. Postoperative MRI showed complete tumor removal in 7 of 10 inactive adenomas; in the group of hormonally active tumors, every patient was successfully treated except for one parasellar STH-adenoma.

Conclusions: The endoscopic biportal approach offered feasible and satisfactory transsphenoidal exposure. In the case of recurrent or residual tumors, endoscopic visualization could be adequately supplemented by the use of intraoperative neuronavigation, allowing clear patho-anatomical orientation and increased monitoring of tumor removal. The minimum traumatization of the nasal cavity without using a nasal retractor and the early postoperative improvement of the patients without nasal packing were additional advantages of the image guided endoscopic biportal technique.