Artikel
Use of intraoperative ultrasound in transsphenoidal surgery for pituitary tumors
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Autoren
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Ali Alomari
- Johannes Wesling Klinikum, Minden, Klinik für Neurochirurgie, Minden, Deutschland
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Ulrich J. Knappe
- Johannes Wesling Klinikum, Minden, Klinik für Neurochirurgie, Minden, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Detection of microadenomas during transsphenoidal may be challenging, as well as resection control of pituitary macroadenomas and preservation of surrounding structures. We describe the use of intraoperative ultrasound (IOUS) in a large series of pituitary tumors for both indications.
Methods: Tow different ultrasound probes were used intraoperatively: an end fire ultrasound-probe (B-mode f 7.5-13 Mhz, field of view 5 mm, penetration 20 mm) in direct contact to the pituitary capsule for detection of microadenomas, and a side fire ultrasound-probe (B-mode f 4 - 13 MHz, linear field, flow mode 6 MHz; diameters 17.6 x 6.9 x 9.4 mm, adjustable depth up to 20 mm) to visualize tumor remnants as well as surrounding parasellar and suprasellar structures during resection of macroadenomas.
Results: Out of 264 consecutive cases undergoing 286 transnasal microsurgical pituitaryoperations within 5 years, IOUS has been used in 63 operations for detection of microadenomas (group I, complete data so far in 47 cases, 13 m, 34 w, 20-69 years, 36 Cushing’s disease, 8 acromegaly, 3 microprolactinomas)and in 146 operations for resection control (group II, complete data so far in 113 cases, 58 m, 55 f, 14-81 years, 110 pit. adenomas, mean diameter 26.6 mm, 29 Knosp °0, 15 °I, 29 °II, 24 °III and 13 ° IV, 69 non-secreting adenomas, 41 secreting adenomas). In group I remission has been achieved in 34 of 47 patients (72%). Adenomas were positive in MRI in 32/47 (68%) patients, IOUS was positive in 39/47 (83%): hyperechogene 16, hypoechogene 10, hyperechogene center with hypoechogene border 11, inhomogeneous 2. Adenomas were negative in MRI and positive in IOUS in 10 cases (21%), all with Cushing’s disease. In group II, using the side fire ultrasound-probe, it was possible to identify the ICA within the cavernous sinus, and the optic nerve in all cases, allowing resection of tumor remnants close to these structures. After IOUS during 65 operations (58%) further resection was performed. Complete resection (stated by MRI after 3 months) was achieved in 75 cases (66%) and remission of hypersecretion syndromes was achieved in 18 patients (44%). No complication due to IOUS was observed.
Conclusion: Direct contact IOUS is a useful tool for detection of microadenomas even invisible on MRI. Moreover, in macroadenomas intracavitary IOUS safely directs resection even in difficult cases.
