The use of intraoperative suprasellar pneumocisternogram for resection of large pituitary tumors

Abstract

Adequate removal of large pituitary tumors with significant suprasellar extension remains a challenge through the trans-sphenoidal corridor because of this route's limited working window. The application of intracisternal air and intraoperative fluoroscopy is explored as a form of intraoperative imaging to maximize tumor resection and to confirm adequate suprasellar tumor decompression. The authors confirmed adequate decompression of suprasellar space using this technique of fluoroscopy with the present intrathecal air for 10 of 12 patients with giant, non-functioning pituitary tumors. Intraoperative cerebrospinal fluid fistulae prevented the use of intrathecal air in the remaining two patients.