Combined Endoscopic Endonasal and Video-microscopic Transcranial Approach with Preoperative Embolization for a Posterior Pituitary Tumor

Yoshida, Keisuke; Toda, Masahiro; Akiyama, Takahiro; Takahashi, Satoshi; Nishimoto, Masaaki; Ozawa, Hiroyuki; Ikari, Yuichi; Yoshida, Kazunari

doi:10.1016/j.wneu.2018.07.245

Cited by 19 publications

(10 citation statements)

References 40 publications

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“…It has also been used for transcranial pituitary surgery [ 20 ]. However, for a long time, it was not considered to be feasible for transsphenoidal approaches [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

4K 3-dimensional video microscope system (orbeye) for transsphenoidal pituitary surgery

et al. 2021

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Background In previous reports on experiences with an exoscope, this new technology was not found to be applicable for transsphenoidal pituitary surgery. As a specialized center for pituitary surgery, we were using a 4K 3D video microscope (Orbeye, Olympus) to evaluate the system for its use in transsphenoidal pituitary surgery in comparison to conventional microscopy. Method We report on 296 cases performed with the Orbeye at a single institution. An observational study was conducted with standardized subjective evaluation by the surgeons after each procedure. An objective measurement was added to compare the exoscopic and microscopic methods, involving surgery time and the initial postoperative remission rate in matched cohorts. Results The patients presented with a wide range of pathologies. No serious events or minor complications occurred based on the usage of the 4K 3D exoscope. There was no need for switching back to the microscope in any of the cases. Compared to our microsurgically operated collective, there was no significant difference regarding duration of surgery, complications, or extent of resection. The surgeons rated the Orbeye beneficial in regard to instrument size, positioning, surgeon’s ergonomics, learning curve, image resolution, and high magnification. Conclusions The Orbeye exoscope presents with optical and digital zoom options as well as a 4K image resolution and 3D visualization resulting in better depth perception and flexibility in comparison to the microscope. Split screen mode offers the complementary benefit of the endoscope which may increase the possibilities of lateral view but has to be evaluated in comparison to endoscopic transsphenoidal procedures in the next step.

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“…It has also been used for transcranial pituitary surgery [ 20 ]. However, for a long time, it was not considered to be feasible for transsphenoidal approaches [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

4K 3-dimensional video microscope system (orbeye) for transsphenoidal pituitary surgery

et al. 2021

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“…As shown in Table 2, there are increasing reports using digital microscope with 4K-3D camera since 2018 [2,10,11]. However, video microscopes with conventional 2K-3D cameras are still currently reported [12,13,14,15,16,17,18,19]. Notably, our report was the first utilizing a video microscope with 8K-UHD camera.…”

Section: Discussionmentioning

confidence: 79%

Mechanism and design of a novel 8K ultra-high-definition video microscope for microsurgery

Yamashita

Kobayashi

2021

Heliyon

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The practical application of microscopes using 8K ultra-high definition (UHD) technology is progressing. However, due to insufficiencies in factors such as luminous intensity and stereopsis, it has not been possible to achieve sufficient image quality for close observation of submillimeter order microlymphatic anastomosis using a combination of 8K-UHD cameras with a rigid endoscope. We have improved the quality of microsurgery by the introduction of a new heads up 8K-UHD surgical system. Herein, we show the mechanisms of this next-generation technology that makes optical improvements to the electronic image input data, resolving the initial drawback. We have developed a new 8K-UHD digital microscope system with digital zooming to enable maximum 300X magnification of the surgical field. This system has specific lighting settings for shadows dropped in surgical field to expand the three-dimensional effect while still being a monocular camera. The original mechanism and design enable the increase of the depth of field with optimal angles between the imaging direction and approaching direction towards the surgical field. Assessment during a pre-clinical trial using rats demonstrated that it is possible to perform microlymphatic anastomosis in a heads-up position with a 70-inch 8K-UHD monitor and the 8K-UHD monocular camera system. Performing supermicrosurgery is difficult with conventional surgical microscopes. Our results illustrate the application of this new 8K-UHD microscope system to this new field.

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“…The additional support by neuronavigation for microsurgical or endoscopic approach has also been published (3,4,19). Combined endoscopic and microscopic management of pituitary region tumors has also been described in a technical note for pediatric surgery (20), in case reports (21,22) and in few retrospective studies (4,23,24). In the pioneering work of Helal et al in which 37 patients were treated with a combined approach, the additional use of an endoscope was highly beneficial as hidden areas could be visualized in 84% of the patients, and tumor residues were detected in 40.5% (23).…”

Section: Microsurgery Vs Endoscopic Surgery and Our Experiences With Combinationmentioning

confidence: 98%

Combined Microsurgical, Endoscopic and Neuronavigation Assisted Transseptal-Transsphenoidal Resection of Pituitary Tumors

Pojskić

Arnautovic

Kovačević

et al. 2021

ama

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Objective. To describe the technical nuances of multimodal transseptal-transsphenoid surgery for pituitary tumors using a combination of microneurosurgery, neuroendoscopy, and electromagnetic neuronavigation.Materials and Methods. A transnasal approach to the sella is performed endoscopically and widely exposed by an otolaryngologic surgeon. Surgery is next performed by the neurosurgeon with microscope and neuronavigation for microsurgical resection of pituitary tumors. Neuroendoscope is also used at the end of surgery to confirm tumor resection and inspect operative site. During surgery, the patient’s head, angle and height of the microscope, and position of the table are repositionable to allow for multiple angle views. Abdominal fat harvested prior to the procedure is used to ensure cerebrospinal fluid seal.Results. The senior author (KIA) has used the combined approach with 84 consecutive patients. Radical resection was achieved in 66 patients, subtotal in 11, and partial in 7. There were no perioperative complications. Six patients experienced postoperative transient diabetes insipidus. The pituitary gland and stalk were preserved in all cases. Visual symptoms were improved in 78% and endocrinological symptoms in 56% of cases.Conclusion. This combined approach is safe and effective. It increases the efficacy and radicality of surgical resection, helps to preserve the pituitary gland, and improves and resolves preoperatively altered patient hormonal function and impaired vision. It also reduces complications, provides less postoperative pain and discomfort, reduces the surgery time, and enables a shorter hospital-stay.

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Combined Endoscopic Endonasal and Video-microscopic Transcranial Approach with Preoperative Embolization for a Posterior Pituitary Tumor

Cited by 19 publications

References 40 publications

4K 3-dimensional video microscope system (orbeye) for transsphenoidal pituitary surgery

4K 3-dimensional video microscope system (orbeye) for transsphenoidal pituitary surgery

Mechanism and design of a novel 8K ultra-high-definition video microscope for microsurgery

Combined Microsurgical, Endoscopic and Neuronavigation Assisted Transseptal-Transsphenoidal Resection of Pituitary Tumors

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