Ram Z, Shawker T H, Bradford M H, Doppman J L, Oldfield E H
Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA.
J Neurosurg. 1995 Aug;83(2):225-30. doi: 10.3171/jns.1995.83.2.0225.
Microadenomas of the pituitary vary in size, particularly those related to Cushing's disease. They are often not visualized on preoperative magnetic resonance (MR) imaging and may be difficult to find during surgical exploration of the pituitary. To enhance intraoperative localization of pituitary adenomas, we assessed the feasibility of using ultrasound to detect and localize pituitary tumors. Intraoperative ultrasound (IS) in the axial and sagittal planes was performed with an Intrascan system using a 12-MHz mechanically oscillating, end-firing transducer. Interpretation of the scans was performed by two individuals, who were usually blinded to the results of preoperative MR imaging or petrosal sinus sampling. Twenty-eight patients were examined. Eighteen of these patients had microadenomas (1.5-7 mm), all with Cushing's disease; nine had macroadenomas (10-20 mm), three of which were adrenocorticotropic hormone-secreting, three growth hormone-secreting, two thyroid-stimulating hormone-secreting, and one nonfunctioning; and one patient had an intrasellar craniopharyngioma. Normal sellar and parasellar structures, such as intrapituitary cysts, the intracavernous carotid arteries, and the diaphragma sella were easily visualized. Twenty-three of the 28 tumors, including 13 of the 18 microadenomas, were detected on IS (82% sensitivity). Tumors were seen as hyperechoic masses in 19 patients, mixed echogenicity in three, and isoechoic in one. In most macroadenomas IS allowed visualization of the interface between the tumor and the normal pituitary gland. These results indicate the potential of IS to aid the intraoperative localization and definition of pituitary tumors.
垂体微腺瘤大小各异，尤其是那些与库欣病相关的微腺瘤。它们在术前磁共振成像（MR）上常无法显影，在垂体手术探查时可能难以发现。为提高垂体腺瘤的术中定位，我们评估了使用超声检测和定位垂体肿瘤的可行性。使用Intrascan系统，配备12MHz机械振荡、端射式换能器，在轴向和矢状面进行术中超声（IS）检查。由两名人员解读扫描结果，他们通常对术前MR成像或岩下窦采样结果不知情。共检查了28例患者。其中18例患者患有微腺瘤（1.5 - 7毫米），均为库欣病；9例患有大腺瘤（10 - 20毫米），其中3例分泌促肾上腺皮质激素，3例分泌生长激素，2例分泌促甲状腺激素，1例无功能；1例患者患有鞍内颅咽管瘤。鞍内和鞍旁的正常结构，如垂体囊肿、海绵窦内颈动脉和鞍隔，均易于显影。28个肿瘤中的23个，包括18个微腺瘤中的13个，在术中超声检查时被检测到（敏感性为82%）。19例患者的肿瘤表现为高回声团块，3例为混合回声，1例为等回声。在大多数大腺瘤中，术中超声可显示肿瘤与正常垂体之间的界面。这些结果表明术中超声在辅助垂体肿瘤的术中定位和界定方面具有潜力。
