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Updated: May 21, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Development and preclinical evaluation of an endonasal Raman spectroscopy probe for transsphenoidal pituitary adenoma
Victor Blanquez-Yeste1,2, Félix Janelle3, Trang Tran1,2
1Polytechnique Montréal, Engineering Physics Department, Montréal, Québec, Canada.
Significance:
For most patients with pituitary adenomas, surgical resection represents a viable therapeutic option, particularly in cases with endocrine symptoms or local mass effects. Diagnostic imaging, including MRI and computed tomography, is employed clinically to plan pituitary adenoma surgery. However, these methods cannot provide surgical guidance information in real time to improve resection rates and reduce risks of damage to normal tissue during tumor debulking.
Aim:
Here, we present the development of a handheld Raman spectroscopy system that can be seamlessly integrated with transsphenoidal surgery workflows to allow live discrimination of all normal intracranial anatomical structures, including the pituitary gland, and potentially tissue abnormalities such as adenomas.
Approach:
A fiber-optic probe was developed with a form factor compatible with endoscopic systems for endonasal surgeries. The instrument was evaluated in an ex vivo experimental protocol designed to assess its ability to distinguish normal intracranial structures. A total of 274 in situ spectroscopic measurements were acquired from six lamb heads, targeting key anatomical structures encountered in surgery. Support vector machine models were developed to classify tissue types based on their spectral signatures.
Results:
Binary classification models successfully distinguished the pituitary gland from other tissue structures with a sensitivity and a specificity of 100%. In addition, a four-class predictive model enabled accuracy in situ discrimination of four structures of most importance during pituitary adenoma tumor resection, i.e., the pituitary gland, the sella turcica (ST) bone, the optic chiasm, and the ST dura mater.
Conclusions:
This work sets the stage for the clinical deployment of Raman spectroscopy as an intraoperative real-time decision support system during transsphenoidal surgery, with future work focused on clinical integration and the generalization of the approach to include the detection of tissue abnormalities, such as pituitary adenomas.
Insights
A new handheld Raman spectroscopy system can identify the pituitary gland and surrounding tissues during surgery. This technology offers real-time guidance to improve pituitary adenoma resection and minimize damage to healthy structures.
Area of Science:
- Medical technology
- Spectroscopy
- Surgical innovation
Background:
- Surgical resection is a primary treatment for pituitary adenomas.
- Current imaging techniques lack real-time intraoperative guidance.
- Tumor debulking risks damage to normal tissues.
Purpose of the Study:
- To develop a handheld Raman spectroscopy system for real-time tissue discrimination during transsphenoidal surgery.
- To integrate this system into surgical workflows for improved pituitary adenoma resection.
Main Methods:
- A fiber-optic probe compatible with endoscopic systems was developed.
- Spectroscopic measurements were acquired from lamb heads (n=274).
- Support vector machine models were used for tissue classification.
Main Results:
- 100% sensitivity and specificity in distinguishing the pituitary gland from other tissues.
- Accurate in situ discrimination of the pituitary gland, sella turcica bone, optic chiasm, and dura mater.
- Development of a four-class predictive model for critical structure identification.
Conclusions:
- Raman spectroscopy shows promise as an intraoperative decision support tool.
- This technology can enhance real-time guidance during transsphenoidal surgery.
- Future work includes clinical integration and detection of pituitary adenomas.
