Utility of Neuronavigator in Transsphenoidal Reoperations

Abstract

Neuronavigation is an advanced recent technology, which allows controlling of the exact localization of the tumor, the best trajectory to reach it,to minimize damage to the surrounding structures. Its utility in transsphenoidal reoperations for recurrent tumors mainly consists, at the beginning of the approach when the nasal speculum is placed in an exact identification of the midline in the absence of the normal anatomic landmarks because of earlier surgery. In the last 10 years of our large transsphenoidal experience, we had to stop the transsphenoidal reoperation in 2 patients affected by recurrent pituitary adenoma, because of the impossibility of identifying with certainty the midline with a consequent high risk of performing a lateral approach with possible injury to intracavernous carotid artery or cranial nerves, which lie just laterally to the pituitary gland in the cavernous sinuses. In the last 3 years, a neuronavigator was used in 9 cases of transsphenoidal reoperations for tumoral recurrence, with the possibility of identifying the midline and without any risk of intracavernous carotid arteries or cranial nerves injury.