Real-time intraoperative ultrasound imaging of the posterior pituitary gland during endoscopic endonasal approach.

Autor: Juncker RB; Medical Scientist Training Program, The Ohio State University College of Medicine, Columbus, OH, USA., Finger G; Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10th Ave, Columbus, OH, 43210, USA., Damante MA; Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10th Ave, Columbus, OH, 43210, USA., Prevedello LM; Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Prevedello DM; Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10th Ave, Columbus, OH, 43210, USA., Wu KC; Department of Neurosurgery, The Ohio State University Wexner Medical Center, Doan Hall N 1049, 460 W 10th Ave, Columbus, OH, 43210, USA. kyle.wu@osumc.edu.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2024 Nov 15; Vol. 166 (1), pp. 456. Date of Electronic Publication: 2024 Nov 15.
DOI: 10.1007/s00701-024-06353-y
Abstrakt: Purpose: Pituitary adenomas are amongst the most common benign central nervous system tumors, and often require resection via an endoscopic endonasal approach (EEA). Two of the most common associated complications are central diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both are thought to be caused by manipulation of the posterior pituitary gland (PPG), making intraoperative visualization and preservation of this structure critical. Intraoperative endoscopic endonasal ultrasound (IEUS) may present an optimal tool for this purpose. This study aims to describe the appearance and morphology of the PPG on IEUS.
Methods: This study included all pituitary adenoma surgeries during which IEUS was utilized and the PPG was visualized between 1/1/2022, and 12/31/2023. Demographic, clinical, pathological, and radiological data were retrospectively collected. The PPG was described as either hypoechoic, isoechoic, or hyperechoic as compared to the anterior pituitary gland and adenoma, and the morphology of the PPG was further classified as ellipse or crescent shaped.
Results: The PPG was hypoechoic in all 43 cases included in our final cohort (100.0%). Morphologically, the PPG appeared elliptical in 27 cases (62.8%), and crescent shaped in 16 cases (37.2%).
Conclusion: The PPG can typically be visualized by IEUS as a hypoechoic structure immediately anterior to the posterior wall of the sella turcica, with elliptical morphology being the most common appearance. These characteristics can be used by the skull base surgeon to more confidently identify the position and morphology of the PPG intraoperatively for its' preservation.
Competing Interests: Declarations Ethics approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the institutional review board/ethics committee of The Ohio State University (study #2020H0221). Competing interests Dr. Daniel Prevedello is a consultant for Stryker Corp., Medtronic Corp., BK Medical and Integra; he has received an honorarium from Mizuho and royalties from KLS- Martin and ACE Medical. All other authors report no conflict of interest.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)
Databáze: MEDLINE
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