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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Ultrasound-assisted transsphenoidal microsurgery for sellar and perisellar lesions

Meeting Abstract

  • Ulrich J Knappe - Klinik für Neurochirurgie, Johannes Wesling Klinikum, Minden, Germany
  • Jürgen Rolfes - Klinik für Neurochirurgie, Johannes Wesling Klinikum, Minden, Germany
  • Theo Sievert - Klinik für Neurochirurgie, Johannes Wesling Klinikum, Minden, Germany
  • Christian Jaspers - Rheumatologie und Endokrinologie, Johannes Wesling Klinikum, Minden, Germany

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1631

DOI: 10.3205/10dgnc104, URN: urn:nbn:de:0183-10dgnc1048

Published: September 16, 2010

© 2010 Knappe et al.
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Outline

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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.