INTRAOPERATIVE US OF THE PITUITARY-GLAND - WORK-IN-PROGRESS

PURPOSE: To evaluate the use of ultrasound (US) of the pituitary gland during transsphenoidal surgery as a means of detecting microadenomas in patients with Cushing disease. MATERIALS AND METHODS: Thirteen pati ents with Cushing disease and one with acromegaly underwent US during transsphenoidal surgery. Mechanically oscillating transducers (10 MHz [n = 8] or 15 MHz [n = 6]) mounted on a 15-cm-long probe were used. RE SULTS: Seven adenomas were definitely visualized, two were poorly seen , and four were overlooked. Small tumors (<5 mm in diameter) tended to be hypoechoic; larger ones, hyperechoic. All four overlooked adenomas were imaged with the 15-MHz transducer. The cavernous sinuses and int ernal carotid arteries could be seen, but minimal invasion of the medi al wall of the cavernous sinus could not. CONCLUSION: Pituitary microa denemas can be detected with transsphenoidal US; however, evaluation o f larger series with instrumentation developed specifically for transs phenoidal application will be necessary to determine the ultimate valu e of this technique.