A study published in October of 2024 concluded that intraoperative ultrasound (iUS) is a useful tool in the identification of the posterior pituitary gland (PPG) during pituitary adenoma resection.*

Focusing on the use of endoscopic endonasal iUS to visualize the PPG during pituitary adenoma surgery, this study sought to identify the importance of the visualization during surgery in the avoidance of complications such as central diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) which can occur due to the manipulation of the PPG.

The study retrospectively analyzed data from pituitary adenoma surgeries performed between 1/1/22 and 12/31/23 where iUS was used to visualize the PPG. The PPG’s appearance was then categorized as hypoechoic, isoechoic, or hyperechoic compared to the anterior pituitary gland and adenoma. Its morphology was classified as either elliptical or crescent-shaped.

During the study period, iUS imaging was performed with GE HealthCare’s bk5000 ultrasound system and N20P6 (9007) minimally invasive transducer.** The iUS solutions were utilized before dural opening to guide the size of the durotomy, ensure adequate exposure, and evaluate the anatomic relationship of the adenoma to the PPG. Both still images and video recordings of the ultrasound were evaluated for each patient, if available.

At the end of the study, results showed that the PPG appeared hypoechoic to the anterior pituitary gland and adenoma (43/43 cases, 100.0%), and was readily identified as the hypoechoic structure immediately anterior to the posterior wall of the sella turcica. The gland appeared as either ellipse or crescent shaped, with the ellipse shape being more common (27/43, 62.8%) (Figs. 1 and 2). However, the crescent shape was seen more frequently in macroadenomas (43.3% vs. 23.1%) (Fig. 1) likely due to the mass effect exerted on the PPG by larger tumors within the confines of the sella.

The authors of this study concluded, “[iUS] is a useful tool ... [that can help] the skull base surgeon to more confidently identify the position and morphology of the PPG intraoperatively, helping to ensure its preservation and potentially limit complications like DI and SIADH.” (Juncker, 2024, p. 6)

The importance of visualization in intraoperative settings cannot be overstated in cases such as these. Providing real-time imaging, the iUS imaging method enables surgeons to make informed, data-driven surgical decisions and guide procedures. Oftentimes we speak of patient outcomes and while this study cannot directly correlate the two, it does highlight the value of iUS as a helpful tool empowering surgeons during the procedure.

Read the full research article here.

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* GE HealthCare did not sponsor this study, but one of the authors, Daniel Prevedello, MD, is a paid consultant for GE HealthCare. Any statements by Dr. Prevedello in the article are based on his own opinions and on results that were achieved in his unique setting. Since there is no “typical” hospital and many variables exist, i.e. hospital size, case mix, etc. there can be no guarantee that other customers will achieve the same results.

** Not all products or features are available in all markets. This is neither an offer nor an agreement to supply the technologies. Cannot be placed on the market or put into service until it has been made to comply with the Medical Device Regulation requirements for CE marking, and Health Canada Medical Device Regulations.