Endoscopic Endonasal Transsphenoidal Surgery using a Skull Reference Array and Laser Surface Scanning

Abstract

Lesions of the skull base are increasingly being resected via the endoscopic, endonasal, transphenoidal approach. We have successfully treated 33 consecutive patients with pituitary lesions using this technique in combination with BrainLAB skull reference array and laser surface scanning for surgical navigation. This technique affords several advantages over neuronavigation based on adhesive-mounted fiducial registration. Rigid fixation in a Mayfield clamp is not required, which allows for flexibility with respect to positioning of the head during the procedure. This is particularly important as extension and flexion of the head provide greater exposure to the clivus and anterior skull base respectively. Also, this technique obviates the need for additional preoperative MRI, thereby reducing cost and delays.

Key words

pituitary surgery - endoscopic surgery - laser surface scanning

References

• 1 Gendeh BS, Doi M, Selladurai BM, Khalid BA, Jegan T, Misiran K. The role of endoscopic endonasal approach to pituitary tumours: HUKM experience.  Med J Malaysia. 2006;  61 343-348
• 2 Koc K, Anik I, Ozdamar D, Cabuk B, Keskin G, Ceylan S. The learning curve in endoscopic pituitary surgery and our experience.  Neurosurg Rev. 2006;  29 298-305
• 3 Raabe A, Krishnan R, Wolff R, Hermann E, Zimmermann M, Seifert V. Laser surface scanning for patient registration in intracranial image-guided surgery.  Neurosurgery. 2002;  50 797-801 , ; discussion 802–793
• 4 Schwartz TH, Stieg PE, Anand VK. Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging.  Neurosurgery. 2006;  58 ONS44-51
• 5 Snyderman C, Kassam A, Carrau R, Mintz A, Gardner P, Prevedello DM. Acquisition of surgical skills for endonasal skull base surgery: a training program.  Laryngoscope. 2007;  117 699-705
• 6 Snyderman C, Zimmer LA, Kassam A. Sources of registration error with image guidance systems during endoscopic anterior cranial base surgery.  Otolaryngol Head Neck Surg. 2004;  131 145-149
• 7 Snyderman CH, Kassam AB. Endoscopic techniques for pathology of the anterior cranial fossa and ventral skull base.  J Am Coll Surg. 2006;  202 563
• 8 West J, Fitzpatrick JM, Wang MY. et al . Comparison and evaluation of retrospective intermodality brain image registration techniques.  J Comput Assist Tomogr. 1997;  21 554-566
• 9 West JB, Fitzpatrick JM, Toms SA, Maurer Jr CR, Maciunas RJ. Fiducial point placement and the accuracy of point-based, rigid body registration.  Neurosurgery. 2001;  48 810-817

Correspondence