Navigation Assisted Transsphenoidal Approach for Pituitary Tumor

Lee, Seung Hoon; Jung, Eun Jae; Lee, Sang Hag; Lee, Heung Man; Kwon, Soon Young; Choi, Ji Ho; Ahn, Cheol Min

Abstract

The transsphenoidal approach is the choice of surgical approach for the treatment of pituitary tumors located on the upper portion of the sphenoid sinus. The proximity of vital anatomic structures (e.g. optic nerve, carotid artery, carvernous sinus, and anterior cranial fossa) surrounding the sphenoid sinus makes it difficult for surgeons to recognize the precise location during the transsphenoidal approach. We report 16 cases of transsphenoidal approach performed via the navigation system to identify vital anatomic structures and important surgical landmarks. We analyzed 16 patients to perform the transcrural transcolumellar approach under the guidance the navigation system for pituitary tumor resection. For the verification of important anatomic structures during operation, the navigation system demonstrates the position and direction of the probe on CT scans in real time. The intrasphenoidal septum was in the midline in only four cases but not so in the other 12 cases. However, the posterior portion of the bony nasal septum attached to the anterior wall of the sphenoid sinus was located in the mid-portion of the sphenoid sinus in all cases. Without any serious damage to the important structures around the sella turcica, we successfully performed the pituitary tumor operation in all cases. Using the navigation system, we identified the relationship between the sella turcica and surrounding important structures on CT scan in real time, and successfully removed the pituitary tumors without complications. In addition, we suggest that the posterior portion of the bony nasal septum attached to the anterior wall of the sphenoid sinus may be one of the available landmarks for the localization of the midline during a transsphenoidal approach.