gms | German Medical Science

Objective: Although endoscopic surgical procedures have many advantages over microsurgical procedures the lack of stereoscopic vision is a major disadvantage. To overcome this problem 3 D endoscopic systems have been introduced recently and applied during neurosurgical procedures. We report our experience with a 3 D systems during endonasal transsphenoidal surgery (ETS).

Method: In a 12 months period (November 2011 - November 2012) 36 patients (22 males, 61%) underwent ETS to treat (para)sellar pathologies (32 adenomas, 3 pituitary abcesses, 1 petrous apex chordoma). The VisionSense^® system (VSII) with a 0 and 30 degree rigid endoscope (4.9mm diameter) was used during surgery. The images were displayed using a planar stereomirror (dual- flatscreen) system, which uses a double- coated polarized mirror to overlay right and left images. Polarizing light- weight glasses are worn for 3D visualization. Complete pre- and postoperative neuroradiological, endocrinological and ophthalmological status was documented in an institutional data base.

Results: The system could be applied in all patients without the need to switch to a 2D system. The detail accuracy was sufficient to detect very small microadenomas (2 patients with M. Cushing) and also to perform surgery in patients with very large tumors using extended approaches (transplanar and petrous apex). Compared to 2D systems a subjectively improved depth perception was accomplished by the surgical team. No discomfort was reported during surgery. In terms of operation time, rate of resection and postoperative new endocrine deficits no differences are found compared to patients operated with a 2D system. No complication occurred, which were attributed to the 3D system.

Conclusions: The VSII 3D endoscopic system can be safely applied during ETS. A real 3D impression with very good detail accuracy is provided by the system.