THREE‐DIMENSIONAL ENDOSCOPIC PITUITARY SURGERY

2009 ◽  
Vol 64 (suppl_5) ◽  
pp. ons288-ons295 ◽  
Author(s):  
Abtin Tabaee ◽  
Vijay K. Anand ◽  
Justin F. Fraser ◽  
Seth M. Brown ◽  
Ameet Singh ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Depth Perception ◽  
Operative Time ◽  
Compound Eye ◽  
Intraoperative Complications ◽  
Three Dimensional ◽  
Pituitary Surgery ◽  
Extent Of Resection ◽  
3 Dimensional ◽  
Transsphenoidal Pituitary Surgery

Abstract OBJECTIVE We describe a novel 3-dimensional (3-D) stereoendoscope and discuss our early experience using it to provide improved depth perception during transsphenoidal pituitary surgery. METHODS Thirteen patients underwent endonasal endoscopic transsphenoidal surgery. A 6.5-, 4.9-, or 4.0-mm, 0- and 30-degree rigid 3-D stereoendoscope (Visionsense, Ltd., Petach Tikva, Israel) was used in all cases. The endoscope is based on “compound eye” technology, incorporating a microarray of lenses. Patients were followed prospectively and compared with a matched group of patients who underwent endoscopic surgery with a 2-dimensional (2-D) endoscope. Surgeon comfort and/or complaints regarding the endoscope were recorded. RESULTS The 3-D endoscope was used as the sole method of visualization to remove 10 pituitary adenomas, 1 cystic xanthogranuloma, 1 metastasis, and 1 cavernous sinus hemangioma. Improved depth perception without eye strain or headache was noted by the surgeons. There were no intraoperative complications. All patients without cavernous sinus extension (7of 9 patients) had gross tumor removal. There were no significant differences in operative time, length of stay, or extent of resection compared with cases in which a 2-D endoscope was used. Subjective depth perception was improved compared with standard 2-D scopes. CONCLUSION In this first reported series of purely 3-D endoscopic transsphenoidal pituitary surgery, we demonstrate subjectively improved depth perception and excellent outcomes with no increase in operative time. Three-dimensional endoscopes may become the standard tool for minimal access neurosurgery.

scholarly journals In patients undergoing video-assisted thoracic surgery for lung resection, does three-dimensional endoscopic vision provide superior clinical outcomes?

2019 ◽  
Vol 30 (4) ◽  
pp. 588-592
Author(s):  
Karishma Chandarana ◽  
Edward J Caruana
Keyword(s):  
Thoracic Surgery ◽  
Clinical Outcomes ◽  
Operative Time ◽  
Lung Resection ◽  
Three Dimensional ◽  
3 Dimensional ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Sufficient Magnitude ◽  
Study Type

Abstract A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether the use of 3-dimensional endoscopic vision provides superior clinical outcomes to patients undergoing video-assisted thoracic surgery for lung resection. Altogether 231 unique papers were found using the reported search, of which 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four of the 6 papers demonstrated a statistically significant reduction in operative time, although this difference may not be of sufficient magnitude to be relevant clinically. There was no difference in any other outcomes assessed. We therefore conclude that, in patients undergoing video-assisted thoracic surgery for lung resection, 3-dimensional endoscopic vision has no demonstrable impact on perioperative or oncological outcomes, or cost, although it may reduce operative time.

ADVANCED VIRTUAL ENDOSCOPY FORENDOSCOPIC TRANSSPHENOIDAL PITUITARY SURGERY

Neurosurgery ◽  
2006 ◽  
Vol 59 (5) ◽  
pp. 1001-1010 ◽  
Author(s):  
Stefan Wolfsberger ◽  
André Neubauer ◽  
Katja Bühler ◽  
Rainer Wegenkittl ◽  
Thomas Czech ◽  
...  
Keyword(s):  
Dimensional Space ◽  
Three Dimensional ◽  
Virtual Endoscopy ◽  
Image Data ◽  
Pituitary Surgery ◽  
Anatomical Variations ◽  
Anatomical Landmarks ◽  
Transsphenoidal Pituitary Surgery ◽  
The Individual ◽  
Anatomical Space

Abstract OBJECTIVE Virtual endoscopy (vE) is the navigation of a camera through a virtual anatomical space that is computationally reconstructed from radiological image data. Inside this three-dimensional space, arbitrary movements and adaptations of viewing parameters are possible. Thereby, vE can be used for noninvasive diagnostic purposes and for simulation of surgical tasks. This article describes the development of an advanced system of vE for endoscopic transsphenoidal pituitary surgery and its application to teaching, training, and in the routine clinical setting. METHODS The vE system was applied to a series of 35 patients with pituitary pathology (32 adenomas, three Rathke's cleft cysts) operated endoscopically via the transsphenoidal route at the Department of Neurosurgery of the Medical University Vienna between 2004 and 2006. RESULTS The virtual endoscopic images correlated well with the intraoperative view. For the transsphenoidal approach, vE improved intraoperative orientation by depicting anatomical landmarks and variations. For planning a safe and tailored opening of the sellar floor, transparent visualization of the pituitary adenoma and the normal gland in relation to the internal carotid arteries was useful. CONCLUSION According to our experience, vE can be a valuable tool for endoscopic transsphenoidal pituitary surgery for training purposes and preoperative planning. For the novice, it can act as a simulator for endoscopic anatomy and for training surgical tasks. For the experienced pituitary surgeon, vE can depict the individual patient's anatomy, and may, therefore, improve intraoperative orientation. By prospectively visualizing unpredictable anatomical variations, vE may increase the safety of this surgical procedure.

scholarly journals A New Scoring System for Predicting Extent of Resection in Medial Sphenoid Wing Meningiomas Based on Three-dimensional Multimodality Fusion Imaging

2020 ◽  
Author(s):  
Zilan Wang ◽  
Xiaolong Liang ◽  
Yanbo Yang ◽  
Bixi Gao ◽  
Ling Wang ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Scoring System ◽  
Three Dimensional ◽  
Extent Of Resection ◽  
Fusion Imaging ◽  
Bone Invasion ◽  
Predictive Capacity ◽  
Arterial Involvement ◽  
The Mean ◽  
New Scoring

Abstract Background: Three-dimensional (3D) multimodality fusion imaging has been proved to be a promising neurosurgical tool for presurgical evaluation of tumor removal. We aim to develop a scoring system based on this new tool to predict the resection grade of medial sphenoid wing meningiomas (mSWM) intuitively.Methods: We included 46 patients treated for mSWM from 2014 to 2019 to evaluate their tumors’ location, volume, cavernous sinus involvement, vascular encasement and bone invasion by 3D multimodality fusion imaging. A scoring system based on the significant parameters detected by statistical analysis was created and evaluated.Results: The tumor volumes ranged from 0.8 cm3 to 171.9 cm3. A total of 39 (84.8%) patients had arterial involvement. Cavernous sinus (CS) involvement was observed in 23 patients (50.0%) and bone invasion was noted in 10 patients (21.7%). Simpson I resection was achieved in 10 patients (21.7%) and Simpson II resection was achieved in 17 patients (37.0%). Fifteen patients (32.6%) underwent Simpson III resection and 4 patients (8.7%) underwent Simpson IV resections. A scoring system was created. The score ranged from 1 to 10 and the mean score of our patients was 5.3 ± 2.8. Strong positive monotonic correlation existed between the score and resection grade (Rs = .772, P < .001). The scoring system had good predictive capacity with an accuracy of 69.60%.Conclusions: We described a scoring system that enabled neurosurgeons to predict extent of resection and outcomes for mSWM preoperatively with 3D multimodality fusion imaging.Trial registration: Retrospectively registered.

Ophthalmoplegic complications in transsphenoidal pituitary surgery

2020 ◽  
Vol 133 (3) ◽  
pp. 693-701
Author(s):  
Simona Mihaela Florea ◽  
Thomas Graillon ◽  
Thomas Cuny ◽  
Regis Gras ◽  
Thierry Brue ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Transsphenoidal Surgery ◽  
Rare Complication ◽  
Pituitary Surgery ◽  
The Other ◽  
Nerve Lesion ◽  
Incomplete Resection ◽  
Transsphenoidal Pituitary Surgery ◽  
Important Extension ◽  
Grade 3

OBJECTIVEOphthalmoplegia is a rare complication of transsphenoidal surgery, only noted in a few studies. The purpose of this study was to analyze the complications of cranial nerve III, IV, or VI palsy after transsphenoidal surgery for pituitary adenoma and understand its physiopathology and outcome.METHODSThe authors retrospectively analyzed 24 cases of postoperative ophthalmoplegia selected from the 1694 patients operated via a transsphenoidal route in their department.RESULTSTwo patients were operated on via microscopy and 22 via endoscopy. Patients operated on endoscopically had a greater risk of presenting with an extraocular nerve deficit postoperatively (p = 0.0115). It was found that an extension into or an invasion of the cavernous sinus (Knosp grade 3 or 4 on MRI, 18/24 patients) was correlated with a higher risk of postoperative ophthalmoplegia (p < 0.0001). The deficit was apparent immediately after surgery in 2 patients. For these 2 patients, the mechanisms of ophthalmoplegia were compression or intraoperative nerve lesion. The other 22 patients became symptomatic in the 12–72 hours following the surgery. The mechanisms implied in these cases were intrasellar compressive hematoma (4/22 cases), intracavernous hemorrhagic suffusion, or incomplete resection of the intracavernous portion of the tumor. All patients who did not present with oculomotor palsy immediately after surgery completely recovered their deficits in the 3 months that followed, while the other 2 experienced permanent damage.CONCLUSIONSExtraocular nerve dysfunction after transsphenoidal pituitary surgery is a rare complication that occurs more frequently in the case of the invasion or an important extension into the cavernous sinus. In this series, it also appears to be significantly more frequent in patients operated on via an endoscopic approach. Most patients have deficits that appear with a delay of 12–72 hours postoperatively and they are most likely to completely recover.

Comparative effectiveness and safety of 3D versus 2D endoscopy in skull base surgery: a systematic review

2015 ◽  
Vol 3 (3-4) ◽  
Author(s):  
Hani J. Marcus ◽  
Yizhou Wan ◽  
Nils H. Ulrich ◽  
Robert Reisch
Keyword(s):  
Clinical Studies ◽  
Operating Time ◽  
Pituitary Surgery ◽  
Extent Of Resection ◽  
Cochrane Central Register ◽  
3 Dimensional ◽  
Central Register ◽  
Significant Difference ◽  
Retrospective Cohort Studies ◽  
2D And 3D

AbstractThe recent introduction of 3-dimensional (3D) endoscopes may improve depth perception, but this must be balanced against their higher cost, larger size, and greater weight.The Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed databases were searched between January 1990 and December 2014. Titles and abstracts were screened to identify publications that (1) featured adult patients, (2) compared 2D and 3D endoscopy, and (3) reported on effectiveness or safety.A total of 163 articles were pooled from the electronic databases. After exclusion, six articles were identified that satisfied the inclusion criteria, comprising three preclinical studies, two retrospective cohort studies, and one case-control study. In the clinical studies a total of 244 patients undergoing endoscopic pituitary surgery were reported – 140 (57.4%) with 2D HD endoscopes, and 104 (42.6%) with 3D SD endoscopes. There was no significant difference in the extent of resection, operating time, or complications, between the 2D and 3D groups.Larger prospective clinical studies comparing 3D and 2D are warranted to determine the extent to which subjective improvements in perception lead to objective improvements in patient outcome.

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