2026 Proffered Presentations
S090: IMPACT OF INTRAOPERATIVE ULTRASONOGRAPHY IN ENDOSCOPIC ENDONASAL RESECTION OF SELLAR AND SUPRASELLAR PATHOLOGIES.
Chandrima Biswas, MD1; Ludovica Pasquini, MD2; Moataz Abouammo, MD3; Rodrigo Gehrke, MD3; Ricardo L Carrau, MD3; Daniel M Prevedello3; 1All India Institute of Medical Sciences, Deoghar; 2Fondazione IRCCS Instituto Neurologico Carlo Besta; 3The Ohio State University and Wexner Medical Centre
Background: Although most diseases affecting the sella and suprasellar region are benign, the presence of critical neurovascular structures contributes to early symptoms and potential for postoperative morbidity. The overlapping radiologic characteristics of these lesions make it difficult to define the surgical goal preoperatively. We assessed the role of intraoperative ultrasound (IOUS) in surgical decision making and detecting inadvertent residual during resection.
Material and Methods: This is retrospective study on 103 cases (108 surgeries) between January 2022 to December 2024 that underwent endoscopic endonasal resection for sellar pathology using IOUS. The performance of IOUS in detecting residual disease was compared with postoperative MRI.
Results: The mean age of the cohort was 57 years, and 53.6% were males. Non-secreting pituitary adenomas were the predominant entity (43.6%) followed by secreting adenomas (31.8%), Rathke’s cleft cyst (11.8%), craniopharyngiomas (5.3%), abscess (2.7%), tuberculum sellae meningiomas (1.8%) and others (hypophysitis, teratoma and collision tumor). Tumors primarily involving the sella were 86.5%, 12.7% were suprasellar and 0.9% primarily involved the cavernous sinus. Three cases that were suspected to be cystic adenomas on preoperative MRI underwent IOUS-guided cyst aspiration, which demonstrated mucinous content suggesting Rathke’s cleft cyst, and hence, marsupialization was deemed adequate. Another three cases suspected to be papillary craniopharyngiomas (PCP) on preoperative MRI demonstrated calcific shadows on IOUS, suggestive of adamantinomatous craniopharyngioma, precluding a conservative resection, which could suffice for PCP in the era of BRAF inhibitors. Gross total resection (GTR) was achieved in 83.3% cases and average residue volume was 3.68cc. IOUS prevented early termination of resection in 10 cases and thus helped achieve GTR in each of them. A total of 16 (53.3%) residual disease was missed on IOUS, average residue volume missed was 0.7cc, the lateral compartment of the cavernous sinus (CS) was the most common site that alluded detection. The specificity of IOUS in detecting residual disease was 85.2% while sensitivity was 46.7%. Disease extension into the CS and suprasellar sellar cistern significantly affected the ability of the IOUS to identify residual disease (p=0.003) and it was more likely to miss residual diseases in cases of giant adenomas than smaller pituitary adenomas. Postoperative visual deterioration was noted in one patient who was developed a small post-operative hematoma. New onset prolonged endocrinological abnormalities were seen in 5 patients and absence of biochemical remission in one patient with a growth hormone producing adenoma.
Conclusion: IOUS helps in surgical decision-making intraoperatively to achieve maximum safe resection.
