Artikel
Intraoperative ultrasound for resection control in transsphenoidal pituitary microsurgery
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Autoren
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Ali Al Omari
- Klinik für Neurochirurgie, Johannes Wesling Klinikum, Minden, Deutschland
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Christian Jaspers
- Klinik für Endokrinologie, Johannes Wesling Klinikum, Minden, Deutschland
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Rainer Salbeck
- Klinik für Radiologie, Johannes Wesling Klinikum, Minden, Deutschland
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Ulrich J. Knappe
- Klinik für Neurochirurgie, Johannes Wesling Klinikum, Minden, Deutschland
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Infiltration of the perisellar compartments is a common finding responsible for incomplete removal of pituitary tumors. Intraoperative visualization of parasellar structures is difficult despite advances in microsurgical and endoscopic transsphenoidal surgery. We describe the use of intraoperative direct contact ultrasound (iUS) in a large series of pituitary tumors.
Method: Out of 264 consecutive cases undergoing 286 direct transnasal microsurgical pituitary operations between 01/2009 und 12/2013 in 141 (53%) patients (82 non-secreting adenomas, 54 secreting adenomas (GH 32, PRL 9, ACTH 8, TSH 5), 1 meningeoma, 1 metastasis, and Rathke's cleft cyst, 1 kraniopharyngeoma, 1 xanthogranuloma; 73 male, 68 female; age 14 - 79 years) a side fire ultrasound-probe (UST-533 probe: B-mode frequency 4 - 13 MHz, linear field, flow mode 6 MHz; diameters of probe 17.6 x 6.9 x 9.4 mm. Hitachi-Aloka, Zug, CH) was introduced after wide opening of sellar floor and after intrasellar tumor removal (147 operations; 37 reoperations, 25%). The parasellar and suprasellar space was scanned perpendicular to the axis of the working channel in direct contact to the sellar envelope.
Results: Using colour coded flow mode it was possible to identify the intracavernous course of the ICAs in all cases and to operate safely close to the artery. After iUS in 77 operations further resection was performed (52%).
Prediction of resection was not possible in 6 cases due to air inclusion. After the remaining 141 operations MRI confirmed the statement of iUS concerning resection control in 116 cases (82 %), in 25 operations iUS was false positive or false negative (18%). Complete resection of tumors (stated by postoperative MRI) in this selected series was achieved in 102 patients (including reoperations, 72%).
Conclusions: Investigation of the perisellar compartments with ultrasound probes in direct contact to the sellar envelope enables the surgeon to identify tumor remnants intraoperatively in most of the cases and to perform tailored resection even in infiltrative tumors. The limitations of iUS are fibrosis, air, bone, and limited space due to small intrasellar resection cavities.
