Transnasal Endoscopic Pituitary Surgery-The Role of a CT Scan in Individual Tailoring of Posterior Septum Size Resection.

OBJECTIVE: This study was designed to evaluate the possibility of predicting the minimum size of septal resection for safe tumor extraction in transnasal paraseptal pituitary adenoma resection from preoperative computed tomography scans. METHODS: A retrospective CT scan analysis was performed on 20 patients who underwent endoscopic pituitary surgery at the University Hospital in Ostrava. Virtual insertion of the straight instrument into the sphenoid cavity was simulated using a CT scan. The minimum septal resection size was predicted and compared to various diameters in the nasal cavity. The results were then compared with cadaveric dissections, in which septal resections were performed at 1 cm and 2 cm distances from the anterior sphenoid wall. The association between cadaver dissections and CT scan results was studied. RESULTS: A total of 20 patients who underwent endoscopic transnasal surgery for pituitary adenoma between the years 2020 and 2021 were enrolled in the study. The mean virtual posterior septal size resection needed to reach the medial edge of the ICA with the straight instrument, without infracturing the nasal septum, was 13.2 mm. In cadavers with a 1 cm posterior septal resection, the medial edge of the ICA was reached with the straight instrument. In 2 cm resections, it was possible to reach beyond the lateral edge of the ICA. CONCLUSION: There is no significant correlation between the minimum septal size resection and measured diameters in the nasal cavity. According to our study, a 1 cm resection is sufficient for a non-extended pituitary tumor extraction. More extensive septal resections allow for better maneuverability and overview in the surgical field.

Inter-rater reliability of carotid atherosclerotic plaque quantification by 3-dimensional sonography.

OBJECTIVES: Embolization from atherosclerotic carotid plaques is the most common cause of ischemic stroke; therefore, identification of high-risk plaques by sonography is important. The aim of this study was to investigate the agreement between 2 investigators in the evaluation of sonographic parameters relating to plaque stability. METHODS: The following plaque parameters were assessed: echogenicity, homogeneity, surface, maximum content, and total volume. Serial 2-dimensional (2D) image sequences were obtained. Linear motion of the probe was automatically synchronized with the electrocardiogram. The edges of the plaque in each image were manually identified by the investigators. The total plaque volume was calculated after computer transformation of 2D images into a 3-dimensinoal (3D) format. Inter-rater reliability for echogenicity, homogeneity, and the surface was assessed by the weighted κ coefficient. Parametric values were tested by a paired t test. RESULTS: We enrolled 30 patients (22 male; mean age ± SD, 72 ± 13 years) in the study and evaluated 28 atherosclerotic plaques. Inter-rater agreement values were as follows: homogeneity, 96% (κ = 0.84; P < .001); surface, 90% (κ = 0.77; P < .001); and echogenicity, 86% (κ = 0.60; P < .001). The significance values for plaque content and volume measurement agreement were P = .311 and .312, respectively, and the correlation coefficient was 0.808. CONCLUSIONS: In our study, the agreement between 2 examiners in the evaluation of 2D and 3D sonographic parameters related to plaque stability was good to excellent. The sonographic measurement of plaque volume growth was the most accurate parameter; therefore, 3D sonography may be used for risk assessment of plaques in the future.

Advances in the development of an imaging device for plaque measurement in the area of the carotid artery.

This paper describes the advances in the development and subsequent testing of an imaging device for three-dimensional ultrasound measurement of atherosclerotic plaque in the carotid artery. The embolization from the atherosclerotic carotid plaque is one of the most common causes of ischemic stroke and, therefore, we consider the measurement of the plaque as extremely important. The paper describes the proposed hardware for enhancing the standard ultrasonic probe to provide a possibility of accurate probe positioning and synchronization with the cardiac activity, allowing the precise plaque measurements that were impossible with the standard equipment. The synchronization signal is derived from the output signal of the patient monitor (electrocardiogram (ECG)), processed by a microcontroller-based system, generating the control commands for the linear motion moving the probe. The controlling algorithm synchronizes the movement with the ECG waveform to obtain clear images not disturbed by the heart activity.

Adjusting the input ultrasound image data and the atherosclerotic plaque detection in the carotid artery by the FOTOMNG system.

Stroke is the third most frequent cause of death. Specifically, ischemic stroke accounts for the largest group of this kind of cases. Despite all the advances in medical therapeutic methods, no methods that would reliably reduce mortality from ischemic stroke have been found. Prevention is still the most significant way to combat stroke. When the frequent cause of ischemic stroke is atherosclerotic plaque in the carotid artery, its exploration can help to determine the development of the disease. These problems were very extensively discussed in October 2013 during the XVI International Neurosonology Congress in Sofia organized under the auspices of World Research Neurosonology Group, Bulgarian Neurosonology and Cerebral Hemodynamics Association. Our goal was to develop special modules for carotid artery picture processing (AVI file processing, reparation and reconstruction) and modules containing tools for automated carotid artery plaque detection; and to solve its measurement and three-dimensional modelling of the carotid artery and the plaque. New modules were implemented into the FOTOMNG system and tested on appropriate input data files, which verified their functionality and applicability.