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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Feasibility of intraoperative 3D fluoroscopic image acquisition and its implementation into neuronavigation for pituitary and skull base surgery

Meeting Abstract

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  • Oliver Müller - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Elias Lemonas - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Oliver Gembruch - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Daniela Pierscianek - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Nicolai El Hindy - Klinik für Neurochirurgie, Universitätsklinikum Essen
  • Ulrich Sure - Klinik für Neurochirurgie, Universitätsklinikum Essen

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocP 011

doi: 10.3205/15dgnc409, urn:nbn:de:0183-15dgnc4090

Published: June 2, 2015

© 2015 Müller et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Pituitary surgery has incredibly evolved since the days of Oskar Hirsch and Harvey Cushing. Still, with technology evolving and limits of surgery being under constant changes there is need for improved simple and „on demand“ acquisition of high resolution imaging of the lesions or the surgical corridor itself. It is the aim of this study to examine the feasibility to implement a simple and quick acquisition of a volume data set by 3D fluoroscopy into neuronavigation.

Method: We assessed the implementation of a 3D fluoroscopic data volume (Arcardis Orbic 3D, Siemens, Erlangen, Germany) into neuronavigation (CurveTM, Brainlab, Feldkirchen, Germany) in patients with lesions in the sellar region or the clivus. Patients presenting with extension of their lesion into the bony structures of the sella or in whom the lesion was completely located within the clivus underwent 3D fluoroscopy instead of a preoperative CT scan of the mid facial region including the sella.

Results: A total of nine patients were submitted for endoscopic surgery harboring endocrine inactive tumors (n=3), hormone-secreting tumours (n=4), craniopharyngeoma (n=1), and bony metastasis (n=1). There were 8 male and 1 female patients (aged 50.1years, range 20-76yrs.). Gross total tumor resection was achieved in 8 cases. An extended biopsy was done in 1 (metastasis). 3D fluoroscopic data sets were successfully fused with preoperative MRI in all cases. Precision of neuronavigation within the bony structures was excellent in all cases. Total administered dose volume was mean 36.14 cGycm2 (range 22.37 to 62.03).

Conclusions: The use of 3D fluoroscopy intraoperatively allows on demand acquisition of detailed images of the bony structures which is especially helpful in pituitary and skull base surgery for lesions invading the surrounding structures of the sella or off springing from the clivus. Image fusion with the currently used neuronavigation system was easily done and allowed optimal planning of the safest targeting route to the lesion.