Publication year: 2012
Source:World Neurosurgery
Ryosuke Mori, Tatsuhiro Joki, Yoshinori Matsuwaki, Kostadin Karagiozov, Yuichi Murayama, Toshiaki Abe
Objective We report our initial experience of real time intraoperativeC-arm computed tomography (C arm-CT: DynaCT)-guided navigation surgery for pituitary tumors. Methods Recent advancement of Flat panel technology enables to obtain CT like images by using rotation of C-arm of Digital Subtraction Angiography (DSA) system. Specially designed new suite, which has C-arm CT imaging capability DSA in combination with Navigation system (VectorVision Sky, Brain Lab, Germany) allows neurosurgeons to perform an endoscopic transsphenoidal procedures under real-time navigation support. Thirty one pituitary tumor patients were examined.During or after tumor removal, contrast enhanced DynaCT was conducted to rule out residual tumor in 12 cases. When enhanced tumor was confirmed, additional removal was continued without moving the patients. Results DynaCT and subsequent image transfer to navigation system was performed in all cases without difficulties, requiring only additional 15minutes of surgical time. Sellar fenestration in relation to tumors and absence of hidden hematomas was confirmed in all cases. The contrast enhanced DynaCT was found contributing to a better handling of the residual tumor. In 9 of these 12 cases (75%), residual tumor was detected on DynaCT, consequently further removal was considered. In 2 cases (16%), there was no enhanced lesion, indicating complete removal. Conclusion The proposed technique of intraoperative visualization in the hybrid operating room can be an easy to perform and may be useful adjunct to conventional transsphenoidal surgery for improved resection rate and less cavernous sinus and internal carotid artery injury.
Source:World Neurosurgery
Ryosuke Mori, Tatsuhiro Joki, Yoshinori Matsuwaki, Kostadin Karagiozov, Yuichi Murayama, Toshiaki Abe
Objective We report our initial experience of real time intraoperativeC-arm computed tomography (C arm-CT: DynaCT)-guided navigation surgery for pituitary tumors. Methods Recent advancement of Flat panel technology enables to obtain CT like images by using rotation of C-arm of Digital Subtraction Angiography (DSA) system. Specially designed new suite, which has C-arm CT imaging capability DSA in combination with Navigation system (VectorVision Sky, Brain Lab, Germany) allows neurosurgeons to perform an endoscopic transsphenoidal procedures under real-time navigation support. Thirty one pituitary tumor patients were examined.During or after tumor removal, contrast enhanced DynaCT was conducted to rule out residual tumor in 12 cases. When enhanced tumor was confirmed, additional removal was continued without moving the patients. Results DynaCT and subsequent image transfer to navigation system was performed in all cases without difficulties, requiring only additional 15minutes of surgical time. Sellar fenestration in relation to tumors and absence of hidden hematomas was confirmed in all cases. The contrast enhanced DynaCT was found contributing to a better handling of the residual tumor. In 9 of these 12 cases (75%), residual tumor was detected on DynaCT, consequently further removal was considered. In 2 cases (16%), there was no enhanced lesion, indicating complete removal. Conclusion The proposed technique of intraoperative visualization in the hybrid operating room can be an easy to perform and may be useful adjunct to conventional transsphenoidal surgery for improved resection rate and less cavernous sinus and internal carotid artery injury.
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