Experimental image-guided endoscopic pituitary surgery:: A useful learning model

Objectives: The purpose of this study, which combined image guidance and endocscopic pituitary surgery (EPS), was to test its practicability as a learning tool to acquire the necessary skills in an experimental setting. Methods: Ten cadaver-heads were explored using a standard endoscopic transsphenoidal surgical technique combined with the InstaTrak 3500 (GE Medical Systems, Lawrence, MA, USA) image guidance system. The time taken for the experimental setup and the opticradiologic correlations of topographic landmarks were recorded and photographed. Results: The average time for setting up the system was 11.9 min +/- 2.0, which included head fixation, headset positioning, registration, calibration and verification of the system. With the guidance of the navigation system, the ostium, sellar floor and adjacent structures encountered during EPS could be identified easily and were reflected on the 3D-CT images accurately. Conclusion: The experimental model validated the practicability of image guidance combined with EPS. The non-invasive interactive computer-assisted CT-guided navigational system facilitated the surgical procedure by providing precise spatial relationship between instrument position and adjacent structures. This combination is a useful teaching and learning tool in the cadaver and in patients will be useful, particularly for complex cases and redo-surgery. (c) 2006 Elsevier Ltd. All rights reserved.