The Role of Image Fusion Neuronavigation in Repeated Transsphenoidal Microsurgery for Pituitary Adenomas

Objective: To evaluate the value of image fusion neuronavigation in transsphenoidal microsurgery for pituitary adenomas that recurred or were associated with poorly pneumatized sphenoid sinus (PPSS).

Methods: During a 4-year period, neuronavigation-guided transsphenoidal microsurgery was performed for selected 24 patients with pituitary adenoma. Among them, 18 cases underwent repeat transsphenoidal surgery and 6 cases associated with PPSS received primary operation. The fused images of magnetic resonance (MR) and computed tomography (CT) were used for preoperative planning and intraoperative guidance. The extent of tumor removal was determined by the comparative analysis of pre- and postoperative radiological materials.

Results: All lesions were accurately oriented and approached with the aid of neuronavigation. Fused images allowed simultaneous visualization of the bony structures (sphenoid wall and cavity, sellar floor) and soft tissue (tumor, internal carotid artery, cavernous sinus), as well as the relationship between them. Total tumor removal was achieved in 20 patients, and subtotal and part tumor removal in 2 patients. There was no intracranial hemorrhage and infection. Postoperative transient diabetes insipidus occurred in 7 patients, and cerebrospinal fluid leakage and oculomotor palsy occurred in 1 patient. No recurrence was found in the 22 patients with total or subtotal tumor removal during an average 17.6-month follow-up period.

Conclusions: Image fusion neuronavigation is beneficial to transsphenoidal microsurgical removal of either recurrent pituitary adenomas or pituitary adenomas associated with PPSS. It may provide accurate guidance for the procedure, avoid complications due to misdirection, and achieve a more radical tumor removal.