Rigid Endoscopy for Intraoperative Imaging of Pituitary Adenoma

  • Dale Jonathan WaterhouseEmail author
Part of the Springer Theses book series (Springer Theses)


The pituitary gland is a pea-sized organ situated behind the ridge of the nose, attached to the base of the brain by a thin stalk. It is a key component of the endocrine system, responsible for hormonal control of other glands as well as many aspects of normal functioning including growth and blood pressure. The most common disease associated with the pituitary gland is pituitary adenoma, the development of a benign tumour. During surgical resection of pituitary adenoma, a delicate balance must be struck between maximising completeness of tumour resection and preserving endocrine function by conserving the normal pituitary. Currently, resection is guided by white light imaging, but it is often difficult to delineate the normal pituitary gland and the adenoma. This Chapter reviews the current standard of care for intraoperative imaging of pituitary adenoma and describes the development of a multispectral endoscope designed to address the clinical need for improved visualisation during resection.


  1. 1.
    Ezzat S et al (2004) The prevalence of pituitary adenomas: a systematic review. Cancer 101:613–619CrossRefGoogle Scholar
  2. 2.
    Theodros D, Patel M, Ruzevick J, Lim M, Bettegowda C (2015) Pituitary adenomas: historical perspective, surgical management and future directions. CNS Oncol 4:411–429CrossRefGoogle Scholar
  3. 3.
    Kuo JS et al (2016) Congress of neurological surgeons systematic review and evidence-based guideline on surgical techniques and technologies for the management of patients with nonfunctioning pituitary adenomas. Neurosurgery 79:E536–E538CrossRefGoogle Scholar
  4. 4.
    Hazer DB et al (2013) Treatment of acromegaly by endoscopic transsphenoidal surgery: surgical experience in 214 cases and cure rates according to current consensus criteria. J Neurosurg 119:1467–1477CrossRefGoogle Scholar
  5. 5.
    Acebes JJ, Martino J, Masuet C, Montanya E, Soler J (2007) Early post-operative ACTH and cortisol as predictors of remission in cushing’s disease. Acta Neurochir 149:471–477CrossRefGoogle Scholar
  6. 6.
    Bao X et al (2016) Extended transsphenoidal approach for pituitary adenomas invading the cavernous sinus using multiple complementary techniques. Pituitary 19:1–10CrossRefGoogle Scholar
  7. 7.
    Berkmann S, Schlaffer S, Buchfelder M (2013) Tumor shrinkage after transsphenoidal surgery for nonfunctioning pituitary adenoma. J Neurosurg 119:1447–1452CrossRefGoogle Scholar
  8. 8.
    Esquenazi Y et al (2017) Endoscopic endonasal versus microscopic transsphenoidal surgery for recurrent and/or residual pituitary adenomas. World Neurosurg 101:186–195CrossRefGoogle Scholar
  9. 9.
    Verstegen MJT et al (2016) Intraoperative identification of a normal pituitary gland and an adenoma using near-infrared fluorescence imaging and low-dose indocyanine green. Oper Neurosurg 12:260–267CrossRefGoogle Scholar
  10. 10.
    Buchfelder M, Schlaffer SM (2012) Intraoperative magnetic resonance imaging during surgery for pituitary adenomas: pros and cons. Endocrine 42:483–495CrossRefGoogle Scholar
  11. 11.
    Akutsu N, Taniguchi M, Kohmura E (2016) Visualization of the normal pituitary gland during the endoscopic endonasal removal of pituitary adenoma by narrow band imaging. Acta Neurochir 158:1977–1981CrossRefGoogle Scholar
  12. 12.
    Rigante M et al (2017) Preliminary experience with 4K ultra-high definition endoscope: analysis of pros and cons in skull base surgery. Acta Otorhinolaryngol Ital 237–241Google Scholar
  13. 13.
    Sandow N, Klene W, Elbelt U, Strasburger CJ, Vajkoczy P (2015) Intraoperative indocyanine green videoangiography for identification of pituitary adenomas using a microscopic transsphenoidal approach. Pituitary 18:613–620CrossRefGoogle Scholar
  14. 14.
    Litvack ZN, Zada G, Laws ER (2012) Indocyanine green fluorescence endoscopy for visual differentiation of pituitary tumor from surrounding structures. J Neurosurg 116:935–941CrossRefGoogle Scholar
  15. 15.
    Lee JYK et al (2017) Folate receptor overexpression can be visualized in real time during pituitary adenoma endoscopic transsphenoidal surgery with near-infrared imaging. J Neurosurg 1–14Google Scholar
  16. 16.
    Yamada S, Takada K (2003) Angiogenesis in pituitary adenomas. Microsc Res Tech 60:236–243CrossRefGoogle Scholar
  17. 17.
    Jugenburg M, Kovacs K, Stefaneanu L, Scheithauer BW (1995) Vasculature in nontumorous hypophyses, pituitary adenomas, and carcinomas: a quantitative morphologic study. Endocr Pathol 6:115–124CrossRefGoogle Scholar
  18. 18.
    Hide T, Yano S, Shinojima N, Kuratsu J (2015) Usefulness of the indocyanine green fluorescence endoscope in endonasal transsphenoidal surgery. J Neurosurg 122:1185–1192CrossRefGoogle Scholar
  19. 19.
    Highlights | KARL STORZ endoskope | United Kingdom. Available at Accessed on 14 Sept 2018
  20. 20.
    van Dam GM et al (2011) Intraoperative tumor-specific fluorescence imaging in ovarian cancer by folate receptor-α targeting: first in-human results. Nat Med 17:1315–1319CrossRefGoogle Scholar
  21. 21.
    Hoogstins CES et al (2016) A novel tumor-specific agent for intraoperative near-infrared fluorescence imaging: a translational study in healthy volunteers and patients with ovarian cancer. Clin Cancer Res 22:2929–2938CrossRefGoogle Scholar
  22. 22.
    Evans C et al (2003) Differential expression of folate receptor in pituitary adenomas. Cancer Res 4218–4224Google Scholar
  23. 23.
    Larysz D et al (2012) Expression of genes FOLR1, BAG1 and LAPTM4B in functioning and non-functioning pituitary adenomas. Folia Neuropathol 50:277–286CrossRefGoogle Scholar
  24. 24.
    Evans C, Yao C, LaBorde D, Oyesiku NM (2008) Chapter 8 folate receptor expression in pituitary adenomas: cellular and molecular analysis. Vitam Horm 79: 235–266Google Scholar
  25. 25.
    Lu G, Fei B (2014) Medical hyperspectral imaging: a review. J Biomed Opt 19:10901CrossRefGoogle Scholar
  26. 26.
    Calin MA, Parasca SV, Savastru D, Manea D (2014) Hyperspectral imaging in the medical field: present and future. Appl Spectrosc Rev 49:435–447ADSCrossRefGoogle Scholar
  27. 27.
    Joshi BP et al (2016) Multimodal endoscope can quantify wide-field fluorescence detection of Barrett’s neoplasia. Endoscopy 48Google Scholar
  28. 28.
    Yang C, Hou V, Nelson LY, Seibel EJ (2013) Color-matched and fluorescence-labeled esophagus phantom and its applications. J Biomed Opt 18:26020CrossRefGoogle Scholar
  29. 29.
    Valdés PA et al (2012) Quantitative, spectrally-resolved intraoperative fluorescence imaging. Sci Rep 2:798CrossRefGoogle Scholar
  30. 30.
    Pelli DG, Bex P (2013) Measuring contrast sensitivity. Vision Res 90:10–14CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Physics and Cancer Research UK Cambridge InstituteUniversity of CambridgeCambridgeUK

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