Multimodal Navigation in Endoscopic Transsphenoidal Resection of Pituitary Tumors using Image-based Vascular and Cranial Nerve Segmentation: A Prospective Validation Study

• Published in: World neurosurgery Vol. 95; pp. 406 - 413
• Main Authors: Dolati, Parviz, MD, Eichberg, Daniel, MD, Golby, Alexandra, MD, Zamani, Amir, MD, Laws, Edward, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2016
• Subjects: ACTH-Secreting Pituitary Adenoma - complications; ACTH-Secreting Pituitary Adenoma - diagnostic imaging; ACTH-Secreting Pituitary Adenoma - surgery; Adenoma - diagnostic imaging; Adenoma - secretion; Adenoma - surgery; Angiography, Digital Subtraction; Arachnoid Cysts - diagnostic imaging; Arachnoid Cysts - surgery; Blood Vessels - diagnostic imaging; Cerebral Angiography; Cranial Nerves - diagnostic imaging; Dermoid Cyst - diagnostic imaging; Dermoid Cyst - surgery; Female; Growth Hormone-Secreting Pituitary Adenoma - diagnostic imaging; Growth Hormone-Secreting Pituitary Adenoma - surgery; Humans; Internal carotid artery; Magnetic Resonance Imaging; Male; Middle Aged; Navigation; Neuroendoscopy - methods; Neuronavigation - methods; Neurosurgery; Optic nerve; Pituitary ACTH Hypersecretion - diagnostic imaging; Pituitary ACTH Hypersecretion - etiology; Pituitary ACTH Hypersecretion - surgery; Pituitary Neoplasms - diagnostic imaging; Pituitary Neoplasms - surgery; Pituitary tumor; Postoperative Complications - epidemiology; Prospective Studies; Segmentation; Surgery, Computer-Assisted - methods; Thyrotropin - secretion; Ultrasonography, Doppler; PP; Segmentation; M1; DI; Transsphenoidal surgery; ACTH; thyroid stimulating hormone; adrenocorticotropic hormone; DS; A2; cavernous sinus; DSA; stalk; Nav probe; first segment of the middle cerebral artery; diabetes insipidus; TSH; TOF; standard error; VF; Pituitary tumor; TSS; Internal carotid artery; cerebrospinal fluid; posterior pituitary; standard deviation; MRI; second segment of the anterior cerebral artery; SD; visual fields; SE; S; OC; T; CSF; growth hormone; ACA; ON; time of flight; dural surface; GH; Optic nerve; Navigation; ICA; digital subtraction angiography; optic chiasm; navigation probe; Cav sinus; tumor; anterior cerebral artery; 3D; Magnetic resonance imaging; MRA
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.06.008

Background Transsphenoidal surgery (TSS) is the most common approach for the treatment of pituitary tumors. However, misdirection, vascular damage, intraoperative CSF 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 localization of neurovascular structures during TSS. Methods Twenty-five patients with pituitary tumors underwent preoperative 3TMRI and Images loaded into the navigation platforms were used for segmentation and pre-operative 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 Pre-operative segmentation of the ICA and cavernous sinus matched with the intra-operative 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 the cases. The accuracy of the measurements was 1.20 + 0.21 mm (mean + SD). Conclusion Image-based pre-operative vascular and neural element segmentation, especially with 3D reconstruction, is highly informative preoperatively and potentially could assist less experienced neurosurgeons in preventing vascular and neural injury during TSS. Additionally, 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.