Preoperative virtual endoscopy and three-dimensional imaging of the surface landmarks of the internal carotid arteries in trans-sphenoidal pituitary surgery

In trans-sphenoidal pituitary adenoma surgery the sella turcica is opened b etween the internal carotid arteries. Three-dimensional image processing me thods were applied in this study to avoid the risk of damaging the arteries during the opening of the anterior wall of the sella. By using graphical s oftware it was possible to combine the anatomies of the carotid arteries an d the sellar wall into one non-perspective three-dimensional image. With a perspective image (virtual endoscopy), the sphenoid sinus landmarks were pr esented as if looking through a nasoendoscope. This also Facilitated preope rative planning but the non-perspective images, with the carotid arteries m arked, were found to be the most useful and suitable for clinical routine. The pituitary tumor itself and its relations with the adjacent structures w ere best evaluated from magnetic resonance imaging scans but, for the openi ng of the sellar wall and in the three-dimensional orientation with endosco py, three-dimensional computerized tomography imaging with the carotid arte ries marked was found to be helpful.