Intraoperative imaging with mobile CT in endoscopic pituitary surgery: An early experience

Abstract

ObjectiveImproving the intraoperative guidance in endoscopic pituitary surgery with Airo CT. MethodsWe report our early experience with mobile CT for intraoperative guidance in pituitary surgery in a series of 30 consecutive patients. The intraoperative CT (iCT) imaging was taken with the patient positioned for surgery. It was automatically fused with the neuronavigation based on the preoperative MR imaging. We analyzed the patients’ data and the tumor characteristics, operative time, extent of resection, duration of stay and post-operative outcome. We compared these data with those of a series of 21 consecutive patients we operated on using surface-matching neuronavigation. ResultsWe noted no significant increase in operating time in the iCT series (170 [127–220] min. vs 180 [139–196] min, p = 0.49). The extent of resection and the clinical outcome were similar in both series (GTR 57.1% in the series without CT vs 60.0 % in iCT series, p = 0.35) as was the visual recovery (92.3% vs 85.7%, p = 1) and the hospital stay (7 [5.8–7.3] vs 6 [5–7] days, p = 0.18). We observed no postoperative diabetes insipidus (DI) in the iCT series while 5 cases of transient DI were reported in the series without CT (23.8%) (p = 0.005). ConclusionsMobile iCT improved the intraoperative guidance and allowed a safe endoscopic adenoma resection with preservation of the healthy gland. Further studies including a larger number of patients are needed to confirm these preliminary results and adequately evaluate the cost-effectiveness of iCT in pituitary surgery.