1
|
Baker KE, Robbins AC, Kumm ZT, Ziemke MK, Washington CW, Luzardo GD, Taylor CS, Stringer SP, Zachariah MA. Case report: Side-firing intraoperative ultrasound guided endoscopic endonasal resection of a clival chordoma. Front Oncol 2023; 13:1039159. [PMID: 36937453 PMCID: PMC10014906 DOI: 10.3389/fonc.2023.1039159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/20/2023] [Indexed: 03/05/2023] Open
Abstract
Clival chordomas are locally invasive midline skull base tumors arising from remnants of the primitive notochord. Intracranial vasculature and cranial nerve involvement of tumors in the paraclival region necessitates image guidance that provides accurate real-time feedback during resection. Several intraoperative image guidance modalities have been introduced as adjuncts to endoscopic endonasal surgery, including stereotactic neuronavigation, intraoperative ultrasound, intraoperative MRI, and intraoperative CT. Gross total resection of chordomas is associated with a lower recurrence rate; therefore, intraoperative imaging may improve long-term outcomes by enhancing the extent of resection. However, among these options, effectiveness and accessibility vary between institutions. We previously published the first use of an end-firing probe in the resection of a clival chordoma. End-firing probes provide a single field of view, primarily limited to depth estimation. In this case report, we discuss the benefits of employing a novel minimally invasive side-firing ultrasound probe as a cost-effective and time-efficient option to navigate the anatomy of the paraclival region and guide endoscopic endonasal resection of a large complex clival chordoma.
Collapse
Affiliation(s)
- Katherine E. Baker
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Austin C. Robbins
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Zeynep T. Kumm
- Department of Pathology, The Ohio State University, Columbus, OH, United States
| | - Michael K. Ziemke
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Chad W. Washington
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Gustavo D. Luzardo
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Charlotte S. Taylor
- Department of Radiology, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Scott P. Stringer
- Department of Otolaryngology, The University of Mississippi Medical Center, Jackson, MS, United States
| | - Marcus A. Zachariah
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS, United States
- *Correspondence: Marcus A. Zachariah,
| |
Collapse
|
2
|
Baker KE, Robbins AC, Wasson RG, McCandless MG, Lirette ST, Kimball RJ, Washington CW, Luzardo GD, Stringer SP, Zachariah MA. Side-firing intraoperative ultrasound applied to resection of pituitary macroadenomas and giant adenomas: A single-center retrospective case-control study. Front Oncol 2022; 12:1043697. [DOI: 10.3389/fonc.2022.1043697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
IntroductionMultiple intraoperative navigation and imaging modalities are currently available as an adjunct to endoscopic transsphenoidal resection of pituitary adenomas, including intraoperative CT and MRI, fluorescence guidance, and neuronavigation. However, these imaging techniques have several limitations, including intraoperative tissue shift, lack of availability in some centers, and the increased cost and time associated with their use. The side-firing intraoperative ultrasound (IOUS) probe is a relatively new technology in endoscopic endonasal surgery that may help overcome these obstacles.MethodsA retrospective analysis was performed on patients admitted for resection of pituitary adenomas by a single surgeon at the University of Mississippi Medical Center. The control (non-ultrasound) group consisted of twelve (n=12) patients who received surgery without IOUS guidance, and the IOUS group was composed of fifteen (n=15) patients who underwent IOUS-guided surgery. Outcome measures used to assess the side-firing IOUS were the extent of tumor resection, postoperative complications, length of hospital stay (LOS) in days, operative time, and self-reported surgeon confidence in estimating the extent of resection intraoperatively.ResultsPreoperative data analysis showed no significant differences in patient demographics or presenting symptoms between the two groups. Postoperative data revealed no significant difference in the rate of gross total resection between the groups (p = 0.716). Compared to the non-US group, surgeon confidence was significantly higher (p < 0.001), and operative time was significantly lower for the US group in univariate analysis (p = 0.011). Multivariate analysis accounting for tumor size, surgeon confidence, and operative time confirmed these findings. Interestingly, we noted a trend for a lower incidence of postoperative diabetes insipidus in the US group, although this did not quite reach our threshold for statistical significance.ConclusionIncorporating IOUS as an aid for endonasal resection of pituitary adenomas provides real-time image guidance that increases surgeon confidence in intraoperative assessment of the extent of resection and decreases operative time without posing additional risk to the patient. Additionally, we identified a trend for reduced diabetes insipidus with IOUS.
Collapse
|