gms | German Medical Science

Objective: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative CT and MRI. Here we report our initial experience of real-time intraoperative computed tomography-guided navigation surgery for pituitary tumors.

Method: We report about 5 cases of pituitary adenomas with supra- and perisellar extension. In these cases we performed a endoscopic transnasal transsphenoidal approach for tumor resection. We used a MRI neuronavigation (Medtronic Stealth Air System) which was registrated via intraoperative CT scan (Siemens CT Somatom suite). Preexisting MR imaging studies (navigation protocol) were fused with the intraoperative CT scans to enable 3D navigation based on MR and CT imaging data.

Results: The intraoperative accuracy of the neuronavigation was excellent. There was an error of less than 1 mm in all cases. The navigation was very helpful for orientation in the sinus sphenoidalis in case of large tumors with a destroyed skull base or in cases of recurrences. Upon intraoperative CT scanning a sufficient tumor resection as intended could be demonstrated.

Conclusions: The use of intraoperative CT/MR imaging-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique.