High-Definition Imaging in Endoscopic Transsphenoidal Pituitary Surgery

Conrad, Jens; Philipps, Mark; Oertel, Joachim

doi:10.2500/ajra.2010.25.3542

Cited by 26 publications

(11 citation statements)

References 22 publications

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“…Schroeder and Nehlsen7 reported higher image resolution and color fidelity with HD neuroendoscopy, particularly when discriminating tumor from neighboring tissue during transnasal transsphenoidal approaches. Conrad et al9 captured a series of images during endoscopic approaches and found significantly improved recognition of anatomic landmarks by surgeons when using HD vs SD cameras (84.4% vs 63.0%; P = .01). The clinical significance of HD visualization has not yet been ascertained, although it is commonly assumed.…”

Section: Discussionmentioning

confidence: 99%

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Comparative Effectiveness of 3-Dimensional vs 2-Dimensional and High-Definition vs Standard-Definition Neuroendoscopy

et al. 2014

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BACKGROUND:Although the potential benefits of 3-dimensional (3-D) vs 2-dimensional (2-D) and high-definition (HD) vs standard-definition (SD) endoscopic visualization have long been recognized in other surgical fields, such endoscopes are generally considered too large and bulky for use within the brain. The recent development of 3-D and HD neuroendoscopes may therefore herald improved depth perception, better appreciation of anatomic details, and improved overall surgical performance.OBJECTIVE:To compare simultaneously the effectiveness of 3-D vs 2-D and HD vs SD neuroendoscopy.METHODS:Ten novice neuroendoscopic surgeons were recruited from a university hospital. A preclinical randomized crossover study design was adopted to compare 3-D vs 2-D and HD vs SD neuroendoscopy. The primary outcomes were time to task completion and accuracy. The secondary outcomes were perceived task workload using the NASA (National Aeronautics and Space Administration) Task Load Index and subjective impressions of the endoscopes using a 5-point Likert scale.RESULTS:Time to task completion was significantly shorter when using the 3-D vs the 2-D neuroendoscopy (P = .001), and accuracy of probe placement was significantly greater when using the HD vs the SD neuroendoscopy (P = .009). We found that 3-D endoscopy significantly improved perceived depth perception (P < .001), HD endoscopy significantly improved perceived image quality (P < .001), and both improved participants’ overall impression (P < .001).CONCLUSION:Three-dimensional neuroendoscopy and HD neuroendoscopy have differing but complementary effects on surgical performance, suggesting that neither alone can completely compensate for the lack of the other. There is therefore strong preclinical evidence to justify 3-D HD neuroendoscopy.ABBREVIATIONS:HD, high definitionSD, standard definition

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Section: Discussionmentioning

confidence: 99%

“…Previous studies have sought to assess the impact of either 3-D or HD neuroendoscopy on surgical performance, with mixed findings 7-9,11-15. A major limitation of all these studies is that they do not allow comparison of the effectiveness of 3-D and HD neuroendoscopy.…”

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confidence: 99%

Comparative Effectiveness of 3-Dimensional vs 2-Dimensional and High-Definition vs Standard-Definition Neuroendoscopy

et al. 2014

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“…1,16 The ability of the endoscope to provide a wide panoramic and detailed view of anatomical structures is the main advantage of endoscopic techniques over microsurgical techniques. 12,13,30 Another advantage of endoscopic techniques compared with microsurgery is the extended view of intra-, para-, and suprasellar structures that may be obtained using angled endoscope optics and angled instruments to visualize and manipulate residual tumor in these areas. 4 In our hands, direct illumination and visualization by the endoscope are easier than and superior to the use of mirrors in microsurgery.…”

Section: Discussionmentioning

confidence: 99%

Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study

Conrad

Ayyad

Wüster³

et al. 2016

JNS

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S urgical approaches to the pituitary gland have undergone numerous refinements over the last 100 years. Successful application of the transseptal transsphenoidal approach to the pituitary gland was first described by Hermann Schloffer in 1906. This procedure became the most commonly used approach for resection of pituitary adenomas and is associated with a low rate of morbidity.29 In 1910, Hirsch described a direct endonasal approach to the sphenoid sinus and to the sella, but this technique included resection of the middle turbinate and parts of the nasal septum.19 Halstead published the sublabial gingival approach in the same year.17 In the 1960s and after introduction of the operating microscope, Hardy combined lateral fluoroscopy with microsurgical techniques. This significantly improved magnification and illumination, reduced the risk of brain injury, und increased abbreviatioNs ACTH = adrenocorticotrophic hormone; ENT = ear, nose, and throat; FSH = follicle-stimulating hormone; GH = growth hormone; IGF-1 = insulin-like growth factor-1; LH = luteinizing hormone; TSH = thyroid-stimulating hormone. obJective Over the past 2 decades, endoscopy has become an integral part of the surgical repertoire for skull base procedures. The present clinical evaluation and cadaver study compare binostril and mononostril endoscopic transnasal approaches and the surgical techniques involved. methods Forty patients with pituitary adenomas were treated with either binostril or mononostril endoscopic surgery. Neurosurgical, endocrinological, ophthalmological, and neuroradiological examinations were performed. Ten cadaver specimens were prepared, and surgical aspects of the preparation and neuroradiological examination were documented. results In the clinical evaluation, 0° optics were optimal in the nasal and sphenoidal phase of surgery for both techniques. For detection of tumor remnants, 30° optics were superior. The binostril approach was significantly more time consuming than the mononostril technique. The nasal retractor limited maneuverability of instruments during mononostril approaches in 5 of 20 patients. Endocrinological pituitary function, control of excessive hormone secretion, ophthalmological outcome, residual tumor, and rates of adverse events, such as CSF leaks and diabetes insipidus, were similar in both groups. In the cadaver study, there was no significant difference in the time required for dissection via the binostril or mononostril technique. The panoramic view was superior in the binostril group; this was due to the possibility of wider opening of the sella in the craniocaudal and horizontal directions, but the need for removal of more of the nasal septum was disadvantageous. coNclusioNs Because of maneuverability of instruments and a wider view in the sphenoid sinus, the binostril technique is superior for resection of large tumors with parasellar and suprasellar expansion and tumors requiring extended approaches. The mononostril technique is preferable for tumors with limited extension in the intra- and...

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“…In dermatology they are implemented for measuring erythema and edema of the skin prick test [45,46,47] or intradermal skin tests [48], for analyzing repigmentation during treatment of vitiligo [49], for quantification of skin lesions [50], and in diagnosis and treatment of atopic dermatitis [51,52]. Otorhinolaryngology makes use of this technique during endoscopic transsphenoidal pituitary surgery [53] and for video-laryngoscopic-assisted surgery [54], while it is used for analysis of body posture in patients with asthma [55,56] in pediatrics. In general it is a suitable method for documentation, communication and education on, for example, orthopedic problems and treatment [57] or photographic documentation in facial plastic surgery [58].…”

Section: Introductionmentioning

confidence: 99%

Objectifying the Conjunctival Provocation Test: Photography-Based Rating and Digital Analysis

Dogan

Astvatsatourov

Deserno

et al. 2013

Int Arch Allergy Immunol

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Background: Patients with allergic rhinoconjunctivitis are susceptible to both nasal and ocular symptoms. The conjunctival provocation test (CPT) is an established diagnostic procedure used in allergic rhinoconjunctivitis, particularly to document a patient's current reactivity to allergens. To date, there are no international guidelines defining the CPT. No approved evaluation method exists for interpreting CPT results. This paper aims to establish the digital analysis of macroimages as an objective, validated and standardized method for interpreting CPT results. Methods: In a clinical immunotherapy trial with 155 patients, treatment progress was documented based on the CPT. Local investigators used a symptom score to grade tearing, reddening and the patients' subjective perception of symptoms (mucosal irritation). A central observer rated conjunctival hyperemia via digital photography. Digital image analysis software was utilized to determine conjunctival hyperemia. Results: Spearman's correlation between the local investigators' and the central observer's ratings was r = 0.729 (p < 0.001); the percentage of total agreement was 48% (based on 739 photos). Digital image analysis (based on 48 photos) had a high percentage of total agreement with the central observer's ratings (69%) but a low percentage of total agreement with the investigators' ratings (38%). The corresponding correlations were r = 0.264 and 0.064, respectively. Conclusion: Photography-based rating by a central observer may represent a valuable supplement to the local investigator's assessment for making an objective evaluation of CPT results. Digital image analysis possesses the potential of being an objective evaluation method compared to the wide-spread subjective evaluation by the investigators.

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High-Definition Imaging in Endoscopic Transsphenoidal Pituitary Surgery

Cited by 26 publications

References 22 publications

Comparative Effectiveness of 3-Dimensional vs 2-Dimensional and High-Definition vs Standard-Definition Neuroendoscopy

Comparative Effectiveness of 3-Dimensional vs 2-Dimensional and High-Definition vs Standard-Definition Neuroendoscopy

Binostril versus mononostril approaches in endoscopic transsphenoidal pituitary surgery: clinical evaluation and cadaver study

Objectifying the Conjunctival Provocation Test: Photography-Based Rating and Digital Analysis

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