Open AccessProposal for Bipolar Coagulation of the Sella Turcica Wall during Pituitary Tumor Operation
Author(s) -
Walter J. Levy
Publication year - 1987
Publication title -
neurosurgery/neurosurgery online
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.485
H-Index - 34
eISSN - 1081-1281
pISSN - 0148-396X
DOI - 10.1227/00006123-198710000-00030
Subject(s) - sella turcica , forceps , medicine , visualization , pituitary tumors , anatomy , radiology , surgery , pathology , computer science , artificial intelligence
Convoluted morphology, limited visualization, and the lack of appropriate instruments limit the surgical approach to the walls of the sella turcica. They are, however, a site of local invasion and retained tumor fragments in cases of pituitary lesions. Effective bipolar coagulation within the sella turcica could reduce recurrence from local invasion, but it is made difficult because rigid bipolar forceps cannot fit effectively or safely against the complex contours of the walls there. Effective coagulation and thorough tumor removal are further frustrated by the lack of direct visualization of either the sella walls or the part of the floor adjacent to the surgical opening. It would be desirable, however, to coagulate the dura mater and retained tumor fragments. As an aid in this problem, we are reporting the use of a flexible bipolar coagulation system in two forms and of a mirror system for visualization in the sella without requiring the removal of one hand from surgical maneuvers. A pair of parallel flexible wire extensions to the standard bipolar forceps can be shaped by the surgeon into a contour that will coagulate the specific local terrain. A web of wire woven into one surface of a cotton patty, which is a bipolar coagulation system, supplements the wire loops. This allows the walls of the sella turcica to be coagulated more effectively where the contours are difficult to gauge and not well visualized. For visualization of the sella turcica walls and floor, we have used a small front surface mirror 1.0 mm thick. With a small suction-cotton patty placed behind the mirror, the mirrior can be used to dry fields or those with a mild ooze. It provides good visualization of the sellar walls when focused on by an operating microscope. In 11 cases, this system was an aid in control of bleeding and allowed coagulation of the sella walls. Furthermore, it has allowed identification of persistent tumor fragments on the sella wall in 3 cases. These fragments were then removed, and their attachment was coagulated. This capability may allow identification and coagulation of tumor that cannot be reached currently. If these sites are so treated, recurrence rates may be reduced significantly.