Preoperative Virtual Endoscopy and Three-Dimensional Imaging of the Surface Landmarks of the Internal Carotid Arteries in Trans-sphenoidal Pituitary Surgery

• Published in: Acta oto-laryngologica Vol. 120; no. 6; pp. 783 - 787
• Main Author: Tomi Talala, Tapio Pirilä, Virpi Karhula, Eero Ilkko, Ilkka Suramo
• Format: Journal Article
• Language: English
• Published: Stockholm Informa UK Ltd 2000; Taylor & Francis; Taylor and Francis
• Subjects: Adenoma - diagnosis; Adenoma - surgery; Adult; Biological and medical sciences; Carotid Artery, Internal - abnormalities; Carotid Artery, Internal - diagnostic imaging; Endocrinopathies; Endoscopy - methods; Female; Humans; Hypothalamus. Hypophysis. Epiphysis (diseases); Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Medical sciences; Monitoring, Intraoperative; Neurosurgery; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Pituitary Neoplasms - diagnosis; Pituitary Neoplasms - surgery; Skull, brain, vascular surgery; Sphenoid Sinus - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; User-Computer Interface; Vascular Surgical Procedures; Endocrinopathy; Performance evaluation; Internal carotid; Adenoma; Damage prevention; Sphenoidal sinus; Surgery; Adult; Female; Pituitary gland; Benign neoplasm; Endoscopy; Human; Radiodiagnosis; Exploration; Virtual image; Sella turcica; Case study; Treatment; Age 20-29; Pituitary diseases; Transsphenoidal pathway; Medical imagery; Surgical approach; Hypophysectomy; Tridimensional image; Computerized axial tomography; Preoperative; Technique
• ISSN: 0001-6489; 1651-2251
• DOI: 10.1080/000164800750000351

In trans-sphenoidal pituitary adenoma surgery the sella turcica is opened between the internal carotid arteries. Three-dimensional image processing methods were applied in this study to avoid the risk of damaging the arteries during the opening of the anterior wall of the sella. By using graphical software it was possible to combine the anatomies of the carotid arteries and the sellar wall into one non-perspective three-dimensional image. With a perspective image (virtual endoscopy), the sphenoid sinus landmarks were presented as if looking through a nasoendoscope. This also facilitated preoperative planning but the non-perspective images, with the carotid arteries marked, were found to be the most useful and suitable for clinical routine. The pituitary tumor itself and its relations with the adjacent structures were best evaluated from magnetic resonance imaging scans but, for the opening of the sellar wall and in the three-dimensional orientation with endoscopy, three-dimensional computerized tomography imaging with the carotid arteries marked was found to be helpful.