Intraoperative acquisition of three-dimensional imaging for frameless stereotactic guidance during transsphenoidal pituitary surgery using the Arcadis Orbic System

Object Intraoperative fluoroscopy has long been used for anatomical localization in transsphenoidal pituitary surgery. More recently, frameless stereotaxy has been used to supplement 2D sagittal radiographs with 3D multiplanar reconstructions. Use of Arcadis Orbic allows both conventional fluoroscopic views and multiplanar reconstructions to be acquired intraoperatively without need for preoperative planning studies. The authors report their initial experience using Arcadis Orbic during transsphenoidal pituitary surgery. Methods To test the system, the authors placed a dehydrated human skull in a radiolucent head holder, and obtained standard 2D fluoroscopic images of the skull base and sella turcica. Arcadis Orbic was then used with frameless stereotaxy to register 3D multiplanar reconstructed images of skull base anatomy. The authors then used Arcadis Orbic in 26 transsphenoidal pituitary tumor resections and compared image quality, accuracy, and ease-of-use to standard techniques. Results Arcadis Orbic 2D fluoroscopic images matched or exceeded the quality of images acquired by standard C-arm machines. Arcadis Orbic multiplanar reconstructions provided excellent images of the skull base when compared with preoperative Stealth computed tomography (CT) studies. Intraoperative frameless stereotactic navigation using Arcadis Orbic was highly accurate and more reliable than registering preoperative CT images. Conclusions Arcadis Orbic provides excellent quality 2- and 3D images during transsphenoidal pituitary surgery, and intraoperative frameless navigation using these images is highly accurate. Arcadis Orbic is easy to use, even in patients with large body habitus, and image acquisition takes no longer than registration during a frameless stereotactic case. Based upon our preliminary experience, Arcadis Orbic precludes the need for preoperative CT studies in patients with pituitary lesions requiring frameless stereotactic navigation.