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Simultaneous combination of electromagnetic navigation with visual evoked potential in endoscopic transsphenoidal surgery: clinical experience and technical considerations

  • Technical Note - Neurosurgical Techniques
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Abstract

Objective

The combination of electromagnetic navigation with continuous monitoring techniques allows for the best available anatomic and real-time functional intraoperative monitoring. Methodological aspects and technical adaptations for this combination of methods and the results from 19 patients with tumors in the pituitary region are reported.

Methods

We retrospectively identified 19 patients who were treated with transsphenoidal surgery using high-resolution endoscopy (eTSS) at our hospital between June 2015 and June 2016. All patients underwent surgery under electromagnetic navigation with visual evoked potential (VEP) monitoring. The cases were reviewed for information on disease, and the distance between the patient tracker and emitter was measured.

Results

In 19 patients, 17 had pituitary adenomas, 1 had a Rathke cleft cyst, and 1 had an arachnoid cyst. The optimal distance between the patient tracker and emitter was 20–25 cm. VEP monitoring could be performed with unaffected recording quality under electromagnetic navigation. Also we were able to perform the registration and eTSS at this distance using both navigation and VEP monitoring.

Conclusions

We performed eTSS for pituitary tumor by simultaneously using electromagnetic navigation and VEP. The optimal distance between the emitter and tracker minimizes VEP monitoring noise and allows accurate electromagnetic navigation.

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Acknowledgements

The authors thank Hiroshi Minabe, Takuma Ohnishi, Yuri Kurokawa, and Hiroko Shimomiya (Division of Medical Support, Okayama University Hospital) for their excellent technical assistance

Authors’ contributions

KK performed the data acquisition, drafted the manuscript, performed the surgical intervention, and revised the manuscript. JI and MK were involved in treating the patient and assisted in the surgical intervention procedure. KK, JI, MK, and ID reviewed the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan

    Kazuhiko Kurozumi, Masahiro Kameda, Joji Ishida & Isao Date

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  1. Kazuhiko Kurozumi
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  2. Masahiro Kameda
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  3. Joji Ishida
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  4. Isao Date
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Corresponding author

Correspondence to Kazuhiko Kurozumi.

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No funding was received for this research.

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 speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-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.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Kurozumi, K., Kameda, M., Ishida, J. et al. Simultaneous combination of electromagnetic navigation with visual evoked potential in endoscopic transsphenoidal surgery: clinical experience and technical considerations. Acta Neurochir 159, 1043–1048 (2017). https://doi.org/10.1007/s00701-017-3111-6

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  • DOI: https://doi.org/10.1007/s00701-017-3111-6

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