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Multimodal Navigation in Endoscopic Transsphenoidal Resection of Pituitary Tumors Using Image-Based Vascular and
Parviz Dolati1, Daniel Eichberg1, Alexandra Golby1
1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Background:
Transsphenoidal surgery (TSS) is the most common approach for the treatment of pituitary tumors. However, misdirection, vascular damage, intraoperative cerebrospinal fluid leakage, and optic nerve injuries are all well-known complications, and the risk of adverse events is more likely in less-experienced hands. This prospective study was conducted to validate the accuracy of image-based segmentation coupled with neuronavigation in localizing neurovascular structures during TSS.
Methods:
Twenty-five patients with a pituitary tumor underwent preoperative 3-T magnetic resonance imaging (MRI), and MRI images loaded into the navigation platform were used for segmentation and preoperative planning. After patient registration and subsequent surgical exposure, each segmented neural or vascular element was validated by manual placement of the navigation probe or Doppler probe on or as close as possible to the target.
Results:
Preoperative segmentation of the internal carotid artery and cavernous sinus matched with the intraoperative endoscopic and micro-Doppler findings in all cases. Excellent correspondence between image-based segmentation and the endoscopic view was also evident at the surface of the tumor and at the tumor-normal gland interfaces. Image guidance assisted the surgeons in localizing the optic nerve and chiasm in 64% of cases. The mean accuracy of the measurements was 1.20 ± 0.21 mm.
Conclusions:
Image-based preoperative vascular and neural element segmentation, especially with 3-dimensional reconstruction, is highly informative preoperatively and potentially could assist less-experienced neurosurgeons in preventing vascular and neural injury during TSS. In addition, the accuracy found in this study is comparable to previously reported neuronavigation measurements. This preliminary study is encouraging for future prospective intraoperative validation with larger numbers of patients.
Insights
Image-based segmentation and neuronavigation accurately map critical structures during transsphenoidal surgery (TSS), enhancing safety and potentially aiding less experienced surgeons in preventing neurovascular injury.
Area of Science:
- Neurosurgery
- Medical Imaging
- Surgical Navigation
Background:
- Transsphenoidal surgery (TSS) is standard for pituitary tumors but carries risks like vascular damage and optic nerve injury, especially for less experienced surgeons.
- Image-based segmentation and neuronavigation offer a potential solution to improve safety and accuracy in TSS.
Purpose of the Study:
- To validate the accuracy of image-based segmentation and neuronavigation in localizing neurovascular structures during transsphenoidal surgery.
- To assess the potential of this technology to assist surgeons in preventing complications.
Main Methods:
- Twenty-five patients with pituitary tumors underwent 3-T MRI for preoperative segmentation and surgical planning.
- Segmentation was validated intraoperatively using a navigation probe and Doppler probe to target neural and vascular elements.
Main Results:
- Preoperative segmentation accurately matched intraoperative findings for the internal carotid artery and cavernous sinus in all cases.
- Image guidance aided optic nerve and chiasm localization in 64% of cases, with a mean accuracy of 1.20 ± 0.21 mm.
Conclusions:
- Image-based segmentation, particularly with 3D reconstruction, is highly informative for preoperative planning in TSS.
- This technology shows promise in assisting surgeons, especially those with less experience, to prevent vascular and neural injuries during TSS.
