Janelle Félix, Blanquez-Yeste Victor, Tran Trang, Khellaf Abdelhakim, Cayrol Romain, Beauregard Catherine, Lacroix André, Weil Alexander G, Lavigne Philippe, Leblond Frédéric, Labidi Moujahed
University of Montreal, Division of Neurosurgery, Department of Surgery, Montreal, Quebec, Canada.
Polytechnique Montréal, Engineering Physics Department, Montréal, Quebec, Canada.
J Biomed Opt. 2025 Aug;30(8):080901. doi: 10.1117/1.JBO.30.8.080901. Epub 2025 Aug 13.
Surgery is a common intervention for patients with pituitary adenomas, particularly those experiencing endocrine symptoms or mass effect. Persistent challenges in pituitary surgery include the detection of small microadenomas, difficulty in discerning residual tumor from normal gland, and infiltrative adenomas. Although standard perioperative diagnostics include magnetic resonance imaging (MRI), computed tomography, ultrasound imaging, and neuronavigation, some centers employ intraoperative MRI, ultrasound, and fluorescence-guided endoscopy to increase the rate of gross total resection and preserve pituitary function. However, these techniques are often limited by availability, time requirements, cost, and inability to provide histological diagnosis.
This review addresses opportunities to optimize both the extent of resection and gland preservation in pituitary adenoma procedures. We discuss the existing constraints faced in pituitary surgery and showcase the current and emerging detection techniques employed in clinical practice, as well as their limitations. We also discuss newer probing approaches such as elastography and Raman spectroscopy.
We outline key attributes for an ideal optical tool, considering surgical theater functionality, ergonomics, and result reliability and accuracy.
A case study is presented describing the recent development of a fiber-optics instrument specifically designed for endonasal applications based on clinical requirements, along with preliminary data supporting the feasibility of intraoperative implementation.
Current imaging and navigation tools, although invaluable, have inherent limitations in resolution, integration, and molecular specificity. Raman spectroscopy offers a promising, label-free method for real-time tissue identification, especially when integrated into fiber-optic probes for endonasal use. As a complementary tool, it could enhance intraoperative decision-making and surgical precision. Further clinical validation is needed to support its integration into standard workflows.
手术是垂体腺瘤患者的常见治疗手段，尤其是对那些出现内分泌症状或占位效应的患者。垂体手术中持续存在的挑战包括小的微腺瘤的检测、区分残留肿瘤与正常腺体的困难以及浸润性腺瘤。尽管标准的围手术期诊断方法包括磁共振成像（MRI）、计算机断层扫描、超声成像和神经导航，但一些中心采用术中MRI、超声和荧光引导内镜检查来提高全切除率并保留垂体功能。然而，这些技术常常受到可用性、时间要求、成本以及无法提供组织学诊断的限制。
本综述探讨了在垂体腺瘤手术中优化切除范围和腺体保留的机会。我们讨论了垂体手术中面临的现有限制，并展示了临床实践中使用的当前和新兴检测技术及其局限性。我们还讨论了诸如弹性成像和拉曼光谱等更新的探测方法。
考虑到手术室功能、人体工程学以及结果的可靠性和准确性，我们概述了理想光学工具的关键特性。
介绍了一个案例研究，描述了一种基于临床需求专门为鼻内应用设计的光纤仪器的最新进展，以及支持术中应用可行性的初步数据。
当前的成像和导航工具虽然非常宝贵，但在分辨率、集成度和分子特异性方面存在固有局限性。拉曼光谱提供了一种有前景的、无需标记的实时组织识别方法，特别是当集成到用于鼻内使用的光纤探头中时。作为一种辅助工具，它可以增强术中决策和手术精度。需要进一步的临床验证来支持将其整合到标准工作流程中。
