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Acta Neurochirurgica

, Volume 161, Issue 1, pp 109–117 | Cite as

Use of intraoperative intracavitary (direct-contact) ultrasound for resection control in transsphenoidal surgery for pituitary tumors: evaluation of a microsurgical series

  • Ali Alomari
  • Christian Jaspers
  • Wolf-Dieter Reinbold
  • Joachim Feldkamp
  • Ulrich J. KnappeEmail author
Original Article - Pituitaries
  • 41 Downloads
Part of the following topical collections:
  1. Pituitaries

Abstract

Background

Perisellar infiltration may be responsible for incomplete removal of pituitary tumors. Since intraoperative visualization of parasellar structures is difficult during transsphenoidal surgery, we are describing the use of intraoperative direct contact ultrasound (IOUS).

Methods

Within 5 years, in 113 transsphenoidal operations (58 male, 55 female, age 14–81 years, 110 pituitary adenomas (mean diameter 26.6 mm, 69 non-secreting adenomas, 41 secreting adenomas), and 1 of each Rathke’s cleft cyst, craniopharyngioma, and xanthogranuloma), IOUS was applied. After wide opening of the sellar floor and removal of the intrasellar tumor portions, a commercially available side fire ultrasound probe is introduced, and in direct contact to the sellar envelope, the perisellar space is scanned perpendicular to the axis of the working channel. We compared the results of IOUS to postoperative MRI after 3–6 months.

Results

Identification of the intracavernous ICA, the anterior optic pathway, and the ACA, was possible, it was safe to operate close to them. In 65 operations (58%), further resection of tumor remnants was performed after IOUS. In this selected series, complete resection of tumors (stated by postoperative MRI after 3–6 months) was achieved in 75 operations (66%) and remission was achieved in 18 operations of secreting adenomas (44%). Compared to MRI after 3 to 6 months, the sensitivity of IOUS was 0.568 and the specificity was 0.907. No complications related to IOUS were seen.

Conclusions

Visualization of the perisellar compartments by IOUS is easy and fast to perform. It allows the surgeon to identify resectable tumor remnants intraoperatively, which otherwise could be missed.

Keywords

Intraoperative ultrasound Pituitary surgery Transsphenoidal surgery Pituitary tumor 

Abbreviations

ACA

Anterior cerebral artery

ACTH

Adrenocorticotropic hormone

ADH

Antidiuretic hormone

A1

A1-segment of ACA

CS

Cavernous sinus

CSF

Cerebrospinal fluid

CT

Computed tomography

GH

Growth hormone

ICA

Internal carotid artery

IGF-1

Insulin-like growth factor 1

IOUS

Intraoperative ultrasound

MRI

Magnetic resonance imaging

OC

Optic chiasm

ON

Optic nerve

PRL

Prolactin

SIADH

Syndrome of inappropriate ADH secretion

TSH

Thyroid-stimulating hormone

Notes

Acknowledgements

This manuscript contains essential parts of the thesis of Dr. Med. Ali Alomari.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speaker’s bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patient-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Ethikkommission der Ärztekammer Westfalen-Lippe, Universität Muenster) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

For this type of study formal consent is not required.

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Copyright information

© Springer-Verlag GmbH Austria, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurosurgery, Johannes Wesling KlinikumUniversity Hospital of Ruhr-Universität BochumMindenGermany
  2. 2.Department of Endocrinology, Johannes Wesling KlinikumUniversity Hospital of Ruhr-Universität BochumMindenGermany
  3. 3.Institute of Radiology and Neuroradiology, Johannes Wesling KlinikumUniversity Hospital of Ruhr-Universität BochumMindenGermany
  4. 4.Department of EndocrinologyKlinikum BielefeldBielefeldGermany

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