TRANS-SELLAR COLOR DOPPLER ULTRASONOGRAPHY DURING TRANSSPHENOIDAL SURGERY

OBJECTIVE: To improve the safety and efficacy of transsphenoidal pitui tary adenoma surgery, we investigated transsphenoidal intraoperative c olor Doppler ultrasonography using a biplane transducer system. METHOD S: We studied 23 patients with pituitary adenomas (18 patients with ma croadenomas and 5 patients with microadenomas) who underwent transsphe noidal surgery. The Hitachi EUB555 color Doppler ultrasound system (Hi tachi Medical, Tokyo, Japan) was used with a pediatric biplane transes ophageal echo cardiography probe (EUP-ES533, 7.5 MHz, biplane phased a rray sector probe, 9.8-mm tip). The probe was inserted into the saline -filled sphenoid sinus after the sellar floor was opened. Intra-and su prasellar images were obtained just before dural incision and after th e tumor removal was thought to have been accomplished. RESULTS: In all patients, the tumor was depicted as a slightly hyperechoic mass, as c ompared with the cerebrum. Using color Doppler imaging, major cerebral arteries were depicted clearly in 74% of patients. The pituitary glan ds, pituitary stalks, and optic chiasms were observed in patients with small adenomas, but not when large adenomas were present. Cavernous s inus invasion, concomitant aneurysm, and residual tumor were clearly v isualized. In patients with large adenomas, the end point of surgery w as decided when there was an ultrasonographically demonstrated collaps ed tumor capsule, subcapsular total vacancy, and reappearance of the o ptic chiasm. CONCLUSION: Trans-sellar color Doppler ultrasonography se ems to be a useful intraoperative guiding system that may improve the safety and efficacy of transsphenoidal surgery.