{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T11:15:51Z","timestamp":1793272551781,"version":"4.5.0"},"reference-count":32,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2011,2]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The authors assessed the feasibility, anatomical accuracy, and cost effectiveness of frameless electromagnetic (EM) neuronavigation in conjunction with portable intraoperative CT (iCT) registration for transsphenoidal adenomectomy (TSA).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A prospective database was established for data obtained in 208 consecutive patients who underwent TSA in which the iCT\/EM navigation technique was used. Data were compared with those acquired in a retrospective cohort of 65 consecutive patients in whom fluoroscope-assisted TSA had been performed by the same surgeon. All patients in both groups underwent transnasal removal of pituitary adenomas or neuroepithelial cysts, using identical surgical techniques with an operating microscope. In the iCT\/EM technique\u2013treated cases, a portable iCT scan was obtained immediately prior to surgery for registration to the EM navigation system, which did not require rigid head fixation. Preexisting (nonnavigation protocol) MR imaging studies were fused with the iCT scans to enable 3D navigation based on MR imaging data. The accuracy of the navigation system was determined in the first 50 iCT\/EM cases by visual concordance of the navigation probe location to 5 preselected bony landmarks. For all patients in both cohorts, total operating room time, incision-to-closure time, and relative costs of imaging and surgical procedures were determined from hospital records.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>In every case, iCT registration was successful and preoperative MR images were fused to iCT scans without affecting navigation accuracy. There was 100% concordance between probe tip location and predetermined bony loci in the first 50 cases involving the iCT\/EM technique. Total operating room time was significantly less in the iCT\/EM cases (mean 108.9 \u00b1 24.3 minutes [208 patients]) compared with the fluoroscopy group (mean 121.1 \u00b1 30.7 minutes [65 patients]; p &lt; 0.001). Similarly, incision-to-closure time was significantly less for the iCT\/EM cases (mean 61.3 \u00b1 18.2 minutes) than for the fluoroscopy cases (mean 71.75 \u00b1 19.0 minutes; p &lt; 0.001). Relative overall costs for iCT\/EM technique and intraoperative C-arm fluoroscopy were comparable; increased costs for navigation equipment were offset by savings in operating room costs for shorter procedures.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The use of iCT\/MR imaging\u2013guided neuronavigation for transsphenoidal surgery is a time-effective, cost-efficient, safe, and technically beneficial technique.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.5.jns091821","type":"journal-article","created":{"date-parts":[[2010,6,18]],"date-time":"2010-06-18T13:52:24Z","timestamp":1276869144000},"page":"329-335","source":"Crossref","is-referenced-by-count":30,"title":["Intraoperative computed tomography registration and electromagnetic neuronavigation for transsphenoidal pituitary surgery: accuracy and time effectiveness"],"prefix":"10.3171","volume":"114","author":[{"given":"Paula","family":"Eboli","sequence":"first","affiliation":[{"name":"Swedish Neuroscience Institute, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bob","family":"Shafa","sequence":"additional","affiliation":[{"name":"Swedish Neuroscience Institute, Seattle, Washington; and"},{"name":"Department of Neurosurgery, UCLA School of Medicine, University of California, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Mayberg","sequence":"additional","affiliation":[{"name":"Swedish Neuroscience Institute, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns091821","series-title":"Acta Neurochir (Wien)","first-page":"763","article-title":"How to overcome the limitations to determine the resection margin of pituitary tumours with low-field intra-operative MRI during transsphenoidal surgery: usefulness of Gadolinium-soaked cotton pledgets","volume":"150","author":"Ahn","year":"2008"},{"key":"b2-jns091821","series-title":"Neurosurgery","first-page":"933","article-title":"Endoscopic endonasal transsphenoidal surgery","volume":"55","author":"Cappabianca","year":"2004"},{"key":"b3-jns091821","series-title":"Computer-Assisted Neurosurgery","first-page":"209","article-title":"Transsphenoidal hypophysectomy","author":"Cunningham","year":"2006"},{"key":"b4-jns091821","series-title":"Neurosurgery","first-page":"271","article-title":"Frameless stereotaxy for transsphenoidal surgery","volume":"45","author":"Elias","year":"1999"},{"issue":"4 Suppl 2","key":"b5-jns091821","series-title":"Neurosurgery","first-page":"244","article-title":"The endonasal microscopic approach for pituitary adenomas and other parasellar tumors: a 10-year experience","volume":"63","author":"Fatemi","year":"2008"},{"key":"b6-jns091821","series-title":"Neurosurgery","first-page":"272","article-title":"Feasibility of Polestar N20, an ultra-low-field intraoperative magnetic resonance imaging system in resection control of pituitary macroadenomas: lessons learned from the first 40 cases","volume":"63","author":"Gerlach","year":"2008"},{"key":"b7-jns091821","series-title":"Surg Neurol","first-page":"648","article-title":"Neuronavigation in pituitary surgery","volume":"52","author":"Hardy","year":"1999"},{"key":"b8-jns091821","series-title":"J Neurosurg","first-page":"612","article-title":"Trans-sphenoidal surgery of pituitary fossa tumors with televised radiofluoroscopic control","volume":"23","author":"Hardy","year":"1965"},{"key":"b9-jns091821","series-title":"J Neurosurg","first-page":"1179","article-title":"Application of electromagnetic technology to neuronavigation: a revolution in image-guided neurosurgery. Technical note","volume":"111","author":"Hayhurst","year":"2009"},{"key":"b10-jns091821","series-title":"Neurosurgery","first-page":"602","article-title":"Endoscopic sphenoidotomy approach to the sella","volume":"41","author":"Heilman","year":"1997"},{"issue":"2","key":"b11-jns091821","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Computer assisted frameless stereotaxy in transsphenoidal surgery at a single institution: review of 176 cases","volume":"20","author":"Jagannathan","year":"2006"},{"key":"b12-jns091821","series-title":"Neurosurgery","first-page":"1302","article-title":"Fluoroscopic frameless stereotaxy for transsphenoidal surgery","volume":"48","author":"Jane","year":"2001"},{"key":"b13-jns091821","series-title":"Neurosurgery","first-page":"1393","article-title":"Endoscopic augmented reality navigation system for endonasal transsphenoidal surgery to treat pituitary tumors: technical note","volume":"50","author":"Kawamata","year":"2002"},{"issue":"1","key":"b14-jns091821","series-title":"Neurosurg Focus","first-page":"E10","article-title":"Image-guided endoscopy: description of technique and potential applications","volume":"19","author":"Mayberg","year":"2005"},{"key":"b15-jns091821","series-title":"Stereotact Funct Neurosurg","first-page":"43","article-title":"Frameless stereotactic navigation in transsphenoidal surgery: comparison with fluoroscopy","volume":"82","author":"McCutcheon","year":"2004"},{"key":"b16-jns091821","series-title":"Acad Radiol","first-page":"1065","article-title":"Comparing 0.2 tesla with 1.5 tesla intraoperative magnetic resonance imaging analysis of setup, workflow, and efficiency","volume":"12","author":"Nimsky","year":"2005"},{"key":"b17-jns091821","series-title":"Radiology","first-page":"67","article-title":"Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients","volume":"233","author":"Nimsky","year":"2004"},{"key":"b18-jns091821","series-title":"Minim Invasive Neurosurg","first-page":"120","article-title":"Endoscopic transnasal approach to the pituitary lesions using a navigation system (InstaTrak system): technical note","volume":"45","author":"Ohhashi","year":"2002"},{"key":"b19-jns091821","series-title":"Neurol Med Chir (Tokyo)","first-page":"565","article-title":"Computer-assisted neurosurgical navigational system for transsphenoidal surgery\u2014technical note","volume":"41","author":"Onizuka","year":"2001"},{"key":"b20-jns091821","series-title":"Stereotact Funct Neurosurg","first-page":"75","article-title":"Application accuracy of an electromagnetic field-based image-guided navigation system","volume":"85","author":"Rosenow","year":"2007"},{"key":"b21-jns091821","series-title":"AJR Am J Roentgenol","first-page":"601","article-title":"The radiology of transsphenoidal hypophysectomy: a review of 100 cases","volume":"127","author":"Rothman","year":"1976"},{"key":"b22-jns091821","series-title":"Acta Neurochir Suppl (Wien)","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/978-3-7091-6043-5_11","article-title":"Cranial surgery and navigation with a compact intraoperative MRI system","volume":"85","author":"Schulder","year":"2003"},{"key":"b23-jns091821","series-title":"J Neurosurg","first-page":"1201","article-title":"Surface-based facial scan registration in neuronavigation procedures: a clinical study. Clinical article","volume":"111","author":"Shamir","year":"2009"},{"key":"b24-jns091821","series-title":"Laryngoscope","first-page":"791","article-title":"Approaches to the sellar and parasellar region: anatomic comparison of the microscope versus endoscope","volume":"109","author":"Spencer","year":"1999"},{"issue":"4 Suppl 2","key":"b25-jns091821","series-title":"Neurosurgery","first-page":"330","article-title":"Neuronavigation without rigid pin fixation of the head in left frontotemporal tumor surgery with intraoperative speech mapping","volume":"60","author":"Suess","year":"2007"},{"key":"b26-jns091821","series-title":"Zentralbl Neurochir","first-page":"126","article-title":"The use of neuronavigation in transnasal transsphenoidal pituitary surgery","volume":"66","author":"Thomale","year":"2005"},{"key":"b27-jns091821","series-title":"Int J Med Robot","first-page":"415","article-title":"Landmark-based augmented reality system for paranasal and transnasal endoscopic surgeries","volume":"5","author":"Thoranaghatte","year":"2009"},{"key":"b28-jns091821","series-title":"Cancer Contr","first-page":"223","article-title":"Microscopic paraseptal sphenoidotomy approach for pituitary tumors","volume":"9","author":"Vrionis","year":"2002"},{"key":"b29-jns091821","series-title":"J Clin Neurosci","first-page":"294","article-title":"Frameless stereotaxy as an alternative to fluoroscopy for transsphenoidal surgery: use of the InstaTrak-3000 and a novel headset","volume":"9","author":"Walker","year":"2002"},{"key":"b30-jns091821","series-title":"Neurosurgery","first-page":"1001","article-title":"Advanced virtual endoscopy for endoscopic transsphenoidal pituitary surgery","volume":"59","author":"Wolfsberger","year":"2006"},{"key":"b31-jns091821","series-title":"Neurosurgery","first-page":"63","article-title":"Transsphenoidal pituitary macroadenomas resection guided by PoleStar N20 low-field intraoperative magnetic resonance imaging: comparison with early postoperative high-field magnetic resonance imaging","volume":"65","author":"Wu","year":"2009"},{"key":"b32-jns091821","series-title":"J Neurosurg","first-page":"350","article-title":"Endonasal transsphenoidal approach for pituitary adenomas and other sellar lesions: an assessment of efficacy, safety, and patient impressions","volume":"98","author":"Zada","year":"2003"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/114\/2\/article-p329.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/114\/2\/article-p329.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/114\/2\/article-p329.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T06:39:32Z","timestamp":1679899172000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/114\/2\/article-p329.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,2]]},"references-count":32,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2010.5.jns091821","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,2]]}}}