SUBLABIAL, TRANSSEPTAL, TRANSSPHENOIDAL APPROACH TO THE PITUITARY REGION GUIDED BY THE ACUSTAR-I SYSTEM

OBJECTIVE: Advances in imaging resolution have resulted in superior vi sualization of intracranial anatomy. Because of the inherent complexit y of the surgical exposure of these lesions, intraoperative localizing techniques are required. Currently, C-arm fluoroscopy provides only t wo-dimensional localization for these anatomic structures. The recentl y described ACUSTAR I system, developed in conjunction with Codman and Shurtleff, Inc. (Randolph, Mass.), is an interactive, image-guided de vice that allows three-dimensional localization with a degree of accur acy previously unattainable. We assessed the clinical utility of the A CUSTAR I system for intraoperative spatial confirmation during transsp henoidal approaches to pituitary lesions. METHODS: Eight patients unde rwent transsphenoidal approaches to pituitary lesions with the assista nce of the ACUSTAR I system. The spatial relationships were clinically judged intraoperatively by the surgeon and by use of traditional C-ar m fluoroscopy and then were compared with the ACUSTAR I system results . RESULTS: In all eight patients, the ACUSTAR I system correctly displ ayed the surgical orientation and provided localization to within less than 1 mm. In two patients, this facilitated the redirection of an er rant approach. No complications were associated with the use of this i mage-guided device. CONCLUSIONS: The ACUSTAR I system is useful in dis playing accurate, three-dimensional anatomic relationships during tran ssphenoidal approaches to pituitary lesions. This system provides crit ical information intraoperatively to redirect errant approaches and pr event significant morbidity.