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The role of osirix based virtual endoscopy in planning endoscopic transsphenoidal surgery for pituitary adenoma

2016; Turkish Neurosurgical Society; Linguagem: Inglês

10.5137/1019-5149.jtn.16311-15.2

2651-5032

Daniel Rotariu, Alexandru Budu, Z. Faiyad, I. Poeată,

Meningioma and schwannoma management

popularized (4,12).The endoscopic technique brings incontestable advantages in terms of illumination, high-resolution, close-up and wide angle view of the structures, the view around the corner, extended maneuverability and decreased trauma of the nasal structures ( 19), but there are also some disadvantages, caused by the different maneuverability of the surgical instruments, the two dimensional images, and the dif-█ INTRODUCTION P ituitary adenoma represents the third most common intracranial tumor (15) and the transsphenoidal approach is nowadays the standard approach for most sellar lesions.The endoscopic transsphenoidal approach is the latest innovation in this field, and since its introduction by Jankowski et al. ( 11) the technique has subsequently been refined and AIm: Virtual endoscopy (VE) is the navigation of a 3D model reconstructed from radiological image data.The aim of this paper is to evaluate the role and accuracy of the virtual endoscopy realized using commercially available software, OsiriX, as a method of planning of surgical interventions.mATERIAl and mEThODS: The computed tomographies of 22 patients with pituitary adenomas proposed for endoscopic approach were reconstructed using OsiriX.VE was performed prior to surgery to assess the surgical corridor and particular anatomy.We evaluated the following landmarks: inferior and middle turbinate, sphenoid ostia (SO), choanal arch (Ch), sphenoethmoidal recess (SER), sphenoid septa, sella turcica, carotid prominences and opticocarotid recesses (OCR).The intraoperative endoscopic images were reviewed and compared with the virtual images. RESUlTS:The virtual images had a good resemblance with the actual surgical images.All the structures from the nasal cavity were identified and had a perfect matching except the SO which was identified in 8 cases in VE vs. 12 intraoperative.All the structures from the sphenoid sinus were identified with perfect matching except the ipsilateral carotid prominence (14 in VE vs. 10 intraoperative) and the contralateral carotid prominence (16 in VE vs. 18 intraoperative).The VE could not show the state of the sellar floor and did not offer any information about the sellar content.CONClUSION: VE realized in OsiriX represents an affordable alternative to the specially designed systems, offering reliable data and good quality images that are useful for the preoperative planning, but some limitations are present such as inability to obtain additional information in cases where the sphenoid sinus is fully occupied by tumor or not aerated, inability to clearly differentiate between structures at the level of the sella, and impossibility to simulate working instruments.