Side-Firing Intraoperative Ultrasonograhy for Resection of Giant Pituitary Adenomas

Austin C Robbins; K Austin Winter; Zachary P Smalley; Saniya Godil; Gustavo Luzardo; Chad W Washington; Daniel M Prevedello; Scott P Stringer; Marcus Zachariah

doi:10.1016/j.wneu.2023.02.049

Side-Firing Intraoperative Ultrasonograhy for Resection of Giant Pituitary Adenomas

World Neurosurg. 2023 May:173:79-87. doi: 10.1016/j.wneu.2023.02.049. Epub 2023 Feb 14.

Authors

Austin C Robbins¹, K Austin Winter¹, Zachary P Smalley¹, Saniya Godil², Gustavo Luzardo¹, Chad W Washington¹, Daniel M Prevedello², Scott P Stringer³, Marcus Zachariah⁴

Affiliations

¹ Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA.
² Department of Neurosurgery, Wexner Medical Center, Ohio State University, Columbus, Ohio, USA.
³ Department of Otolaryngology, University of Mississippi Medical Center, Jackson, Mississippi, USA.
⁴ Department of Neurosurgery, University of Mississippi Medical Center, Jackson, Mississippi, USA. Electronic address: marcus.a.zachariah@gmail.com.

PMID: 36796627
DOI: 10.1016/j.wneu.2023.02.049

Abstract

Background: Suprasellar extension, cavernous sinus invasion, and involvement of intracranial vascular structures and cranial nerves are among the challenges faced by surgeons operating on giant pituitary macroadenomas. Intraoperative tissue shifts may render neuronavigation techniques inaccurate. Intraoperative magnetic resonance imaging can solve this problem, but it may be costly and time consuming. However, intraoperative ultrasonography (IOUS) allows for quick, real-time feedback and may be particularly useful when facing giant invasive adenomas. Here, we present the first study examining technique for IOUS-guided resection specifically focusing on giant pituitary adenomas.

Objective: To describe the use of a side-firing ultrasound probe in the resection of giant pituitary macroadenomas.

Methods: We describe an operative technique using a side-firing ultrasound probe (Fujifilm/Hitachi) to identify the diaphragma sellae, confirm optic chiasm decompression, identify vascular structures related to tumor invasion, and maximize extent of resection in giant pituitary macroadenomas.

Results: Side-firing IOUS allows for identification of the diaphragma sellae to help prevent intraoperative cerebrospinal fluid leak and maximize extent of resection. Side-firing IOUS also aids in confirmation of decompression of the optic chiasm via identification of a patent chiasmatic cistern. Furthermore, direct identification of the cavernous and supraclinoid internal carotid arteries and arterial branches is achieved when resecting tumors with significant parasellar and suprasellar extension.

Conclusions: We describe an operative technique in which side-firing IOUS may assist in maximizing extent of resection and protecting vital structures during surgery for giant pituitary adenomas. Use of this technology may be particularly valuable in settings in which intraoperative magnetic resonance imaging is not available.

Keywords: Adenoma; Intraoperative; Pituitary; Side-firing; Transsphenoidal; Ultrasound.

MeSH terms

Adenoma* / diagnostic imaging
Adenoma* / pathology
Adenoma* / surgery
Humans
Magnetic Resonance Imaging / methods
Microsurgery / methods
Neuronavigation
Neurosurgical Procedures / methods
Pituitary Neoplasms* / diagnostic imaging
Pituitary Neoplasms* / pathology
Pituitary Neoplasms* / surgery
Treatment Outcome