Fluoroscopic frameless stereotaxy for transsphenoidal surgery

OBJECTIVE: To assess the value of frameless fluoroscopy-guided stereotactic transsphenoidal surgery using the FluoroNav Virtual Fluoroscopy System (Me dtronic Sofamor Danek, Inc., Memphis, TN). METHODS: Twenty consecutive patients undergoing transsphenoidal surgery for sellar lesions were assigned to transsphenoidal surgery with or without co mputer-assisted fluoroscopic image guidance using the FluoroNav system. Pro spective data regarding patient age, sex, lesion characteristics, operative time, and treatment cost were obtained. RESULTS: Although patients in the FluoroNav group were, on average, 17 year s younger than the patients in the control group, more patients with recurr ent adenomas were treated in the image guidance group. No other significant differences between the groups were found. FluoroNav provided accurate, co ntinuous information regarding the anatomic midline trajectory to the sella turcica as well as anatomic structures (e.g., sella, sphenoid sinus) in th e lateral view. No patient required reversion to intraoperative videofluoro scopy. No statistically significant differences were found with regard to p reincision setup time, operative time, or cost. FluoroNav allowed procedure s to be performed with significantly fewer x-rays being taken. CONCLUSION: Fluoroscopic computer-assisted frameless stereotaxy furnishes a ccurate real-time information with regard to midline structures and operati ve trajectory. Although it is useful in first-time transseptal transsphenoi dal surgery, its primary benefit is realized in recurrent surgery.