Artikel
Ultrasound-assisted transsphenoidal microsurgery for sellar and perisellar lesions
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Autoren
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Ulrich J Knappe
- Klinik für Neurochirurgie, Johannes Wesling Klinikum, Minden, Germany
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Jürgen Rolfes
- Klinik für Neurochirurgie, Johannes Wesling Klinikum, Minden, Germany
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Theo Sievert
- Klinik für Neurochirurgie, Johannes Wesling Klinikum, Minden, Germany
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Christian Jaspers
- Rheumatologie und Endokrinologie, Johannes Wesling Klinikum, Minden, Germany
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: Use of intraoperative ultrasound (iUS) during transsphenoidal microsurgery addresses (a) resection control of macroadenomas and (b) identification of microadenomas, thus avoiding extensive pituitary exploration and potential procedure-related hypopituitarism.
Methods: (a) For resection control of 38 pituitary macroadenomas and 2 meningeomas a 13 MHz US probe with a perpendicular 10 mm linear field was introduced into the sella after intrasellar tumor removal to investigate the suprasellar and parasellar compartments. (b) In 25 patients (20 with Cushing`s disease, CD) a 13 MHz probe with straight ahead 5 mm linear field was used for identification of microadenomas before opening of the pituitary capsule.
Results: (a) In macroadenomas, total removal was accomplished in 25 out of 38 cases (66%), in 11 Knosp 0IV adenomas a tailored partial resection was performed. Complete remission of hypersecretory syndrome was obtained in 10/17 cases (59%). Two infiltrative meningeomas were partially resected. In 23 out of 40 cases further resection after iUS was undertaken (58%). Compared to postoperative MRI, concerning suprasellar tumor remnants iUS was positive in 2/36 cases, false negative in 2, and not applicable in 5 (due to air, one of those false negative). Concerning parasellar tumor remnants iUS was positive in 13/36 cases (2 meningeomas, 11 Knosp 0IV adenomas), false positive in 1/36 (Knosp 0III adenoma), and false negative in 2 cases (Knosp 0II and 0III, acromegaly). (b) In CD, 15 out of 19 microadenomas were identified by iUS (79%), including 3/4 cases with negative preoperative MRI. Remission rate of hypercortisolism was 20/20 (100%), other pituitary function were unaltered compared to preoperative state in 19/20 cases (95%). No complications related to iUS occurred.
Conclusions: iUS with high-frequency probes during transsphenoidal surgery improves (a) the resection rate of infiltrative macroadenomas, (b) the finding rate of microadenomas in CD, and the endocrinological outcome.
