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Image guidance in pit ad


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Image guidance in pit ad

  1. 1. Image Guidance in Trans-Sphenoidal Surgery of Pituitary Adenomas: Luxury or Necessity? Deepak Agrawal MS Sharma, SS Kale, BS Sharma Department of Neurosurgery & Gamma Knife All India Institute of Medical Sciences, New Delhi-110029
  2. 2. Background <ul><ul><li>In spite of availability of image guidance (neuronavigation) at major centers around the world, most trans-sphenoidal surgeries for pituitary adenomas continue to be done under fluoroscopic control. </li></ul></ul>
  3. 3. FLOUROSCOPY (Image intensifier) <ul><ul><li>Limitations </li></ul></ul><ul><ul><li>radiation exposure </li></ul></ul><ul><ul><li>Only 2D images available </li></ul></ul><ul><ul><li>Inability to confirm midline access to sella </li></ul></ul><ul><ul><li>? Relationship of critical structures like carotid artery </li></ul></ul><ul><ul><li>Lead Aprons- surgeon fatigue </li></ul></ul>
  4. 4. IMAGE GUIDANCE <ul><ul><li>Perceived limitations </li></ul></ul><ul><ul><li>Steep Learning curve </li></ul></ul><ul><ul><li>Preop fiducial based imaging required </li></ul></ul><ul><ul><li>Iincreases operating time </li></ul></ul><ul><ul><li>Requires dedicated personell </li></ul></ul><ul><ul><li>Doubtful benefit </li></ul></ul><ul><ul><li>?Flouroscopy has to be anyway available </li></ul></ul>
  5. 5. IMAGE GUIDANCE <ul><ul><li>ADVANTAGES </li></ul></ul><ul><ul><li>Equisite 3D visualization of midline & carotid arteries </li></ul></ul><ul><ul><li>Not affected by brain shift </li></ul></ul><ul><ul><li>Almost real time guidance </li></ul></ul><ul><ul><li>None of the disadv of flouroscopy </li></ul></ul>
  6. 6. AIMS & OBJECTIVES <ul><ul><li>To study to utility of image guidance in trans-sphenoidal surgeries for pituitary adenomas in a tertiary care teaching hospital </li></ul></ul>