The Role of Virtual Endoscopy in Planning Endoscopic Transsphenoidal Surgery for Pituitary Adenomas

Objective: To realize and navigate the 3D model from CTs of patients and compare them to the intraoperative endoscopic images. Study Design: Prospective observational study. Methods: The CTs of 15 patients proposed for endoscopic approach for pituitary adenoma were reconstructed using OsiriX (Pixmeo Sarl, Geneva, Switzerland). Virtual endoscopy (VE) was performed before surgery to assess the surgical corridor and particular anatomy. We evaluated the inferior and middle turbinate, sphenoid ostia (SO), choanal arch, sphenoethmoidal recess, sphenoid septa, sellar fossa, and paraclival carotid prominences. The intraoperative endoscopic images were compared with the virtual images. Results: The virtual images had a good resemblance with the actual surgical images, all the structures from the nasal cavity were identified and had a perfect matching except the SO which was identified in 8 cases in VE versus 12 intraoperative cases. All the structures from the sphenoid sinus were identified with perfect matching except the ipsilateral paraclival carotid (10 cases in VE vs.5 intraoperative). The VE could not appreciate the state of the sellar floor in none of the cases. Conclusions: The preoperative knowledge of the nasal and sphenoid anatomy may generate benefits during the performance of surgeries, anyhow detailed information concerning the integrity of structures could not be offered by this technique and it offers no additional information in cases where the sphenoid sinus is fully occupied by a tumor or is not aerated.