High-definition imaging in endoscopic transsphenoidal pituitary surgery

The transsphenoidal approach to sellar lesions has evolved enormously since its first description in the early 20th century. Endoscopic surgical strategies have become an integral part of the surgical armamentarium. More recently, high-definition (HD) digital cameras with better image resolution were introduced, although their value for the surgical procedure remains equivocal. The purpose of this study was to compare the image quality of a standard-definition (SD) camera with a new HD camera.

A transsphenoidal pituitary adenomectomy was recorded simultaneously in HD and SD resolution. Eight experienced neurosurgeons were asked to identify predefined as well as not predefined anatomic structures in HD and SD. Additionally, the video quality of three complementary surgical sequences was rated with grades from 1 ("very good") to 6 ("poor").

An average of 23.6 ± 2.7 predefined structures (84.38%) were identified in HD versus 17.6 ± 4.4 predefined structures (62.95%) identified in SD. This profound difference in the recognition of anatomic structures reached statistical significance (p = 0.012). Subjective impression of video quality was rated 1.9, 1.9, and 1.4 for the videos in HD and 3.5, 3.3, and 3.5 for the complementary videos in SD. These differences also reached statistical significance (p ≤ 0.005).

HD imaging in endoscopic transsphenoidal pituitary surgery accounts for significantly better identification of anatomic structures in comparison with SD images. Additionally, the subjective impression of video quality is significantly better in HD. This improved intraoperative orientation by better digital image quality might contribute to reduce the gap in intraoperative visual accuracy between microsurgery and endoscopy in pituitary surgery.