NEURONAVIGATION-GUIDED VERSUS FLUOROSCOPIC-GUIDED MICRONEUROSURGICAL TRANSSPHENOIDAL PITUITARY SURGERY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 28
Abstract
BACKGROUND The transsphenoidal route for resection of pituitary adenomas eliminates the need for craniotomy to expose the pituitary gland. It creates narrow access to a deep region of the skull rich with critical neurovascular structures. To ensure an appropriate trajectory, intraoperative image-guidance has been used in transsphenoidal surgeries for decades. The evolution of image-guidance in pituitary surgery has included the use of intraoperative fluoroscopy, CT, ultrasound and MRI. The neuronavigational systems have been used successfully in the setting of pituitary adenoma resection, but comparative analysis with commonly available fluoroscopic-guided surgery is lacking. The objective of this study is to compare the effectiveness and significance of neuronavigation vs fluoroscopy in transsphenoidal microneurosurgical removal of pituitary adenoma. MATERIALS AND METHODS This is a non-randomised controlled trial. Data of patients who were surgically treated for a pituitary lesion at the Department of Neurosurgery between May 2012 and May 2017 was collected. Age, sex, race, presenting symptoms, length of hospital stay, surgical approach, duration of surgery, tumour pathological features, Gross Total Resection (GTR) of tumour, recurrence of the lesion and intraoperative and postoperative complications were noted. All procedures were performed by the neurosurgical team, who were initially unfamiliar with the neuronavigation approach and therefore used traditional fluoroscopy. RESULTS 30 patients who underwent fluoroscopic-guided and 30 patients who underwent neuronavigation-guided microsurgical removal of pituitary were included in the study. The mean time taken during surgery was significantly less (p < 0.001) in neuronavigation group as compared to the fluoroscopy group. Also, there was significantly less amount of intraoperative blood loss in neuronavigation group. Postoperative residual tumour volume as assessed by a postoperative CT scan was less than 0.5 mL in 67% patients in neuronavigation group, while it was between 1 - 1.5 mL in 60% patients with fluoroscopy. Other postoperative complications like diabetes insipidus, CSF rhinorrhoea, meningitis, vision loss and sinusitis were comparable between the two groups. CONCLUSION The application of neuronavigation in the transsphenoidal surgery for resection of pituitary adenoma can improve the safety of transsphenoidal approach, decreases surgical complications and duration of surgery
Authors and Affiliations
Sharad Pandey, Anurag Sahu, Himanshu Jain, Kulwant Singh, Vivek Sharma
Keywords
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- EP ID EP537902
- DOI 10.14260/jemds/2018/728
- Views 75
- Downloads 0
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