Minim Invasive Neurosurg 2006; 49(2): 93-97
DOI: 10.1055/s-2006-932170
Original Article
© Georg Thieme Verlag Stuttgart · New York

Image-Guided Endonasal Transsphenoidal Microsurgical Treatment of Recurrent Microadenomas of the Pituitary Gland

P.  Charalampaki1 , R.  Reisch1 , A.  Ayad1 , S.  Welschehold1 , J.  Conrad1 , C.  Wüster2
  • 1Department of Neurosurgery, Johannes-Gutenberg University Mainz, Mainz, Germany
  • 2Praxis für Endokrinologie, Mainz, Germany
Further Information

Publication History

Publication Date:
18 May 2006 (online)

Abstract

Background: Neuronavigation is a commonly used technology that provides continuous, three-dimensional information for the precise localization of and surgical trajectory to brain lesions. This study was performed to evaluate the role that navigation can play in assisting microsurgical transsphenoidal surgery for precise localization and removal of recurrent pituitary tumours while simultaneously preserving pituitary gland function. Method: During a 6-month period - July 2004 until December 2004 - 9 patients with recurrent pituitary tumours (5 female and 4-male) were treated with navigation-guided transsphenoidal microsurgical resection. Surgery was performed via a paraseptal or endonasal transsphenoidal approach. The navigation system Vector Vision (Brain Lab, Heimstetten, Germany) allowed precise localization of the tumours (7 hormonal active and 2 inactive microadenomas) in respect to the pituitary gland, the carotid arteries and the cavernous sinus. Results: Postoperative MRI investigations of the 9 patients treated with image-guided transsphenoidal microsurgery, showed total tumour removal in 7 (77 %) patients and subtotal removal in 2 patients (23 %). One patient (11 %) developed a cerebral spinal fluid (CSF) leak and was treated conservatively. One patient (11 %) had preoperative insufficiency of the corticotrope axis which remained unchanged postoperatively. Of the remaining 8 patients who did not have preoperative endocrinological disturbance, only one (12 %) developed postoperative insufficiency of the corticotrope axis. Out of the 7 patients with hormone active tumours, 5 (72 %) patients showed no more postoperative hormonal activity. Conclusion: Microneurosurgical transsphenoidal techniques combined with image-guided systems can precisely define the localization and removal of lesions in the sella region with respect to the margins of important anatomical structures in the neighbourhood and the endocrinological functionality of the pituitary gland.

References

Patra Charalampaki,, M. D. 

Department of Neurosurgery · Johannes-Gutenberg University Mainz

Langenbeckstr. 1

55101 Mainz

Germany

Phone: +49/6131/177/331

Fax: +49/6131/172/274 ·

Email: charalampaki@yahoo.de