Elsevier

World Neurosurgery

Volume 126, June 2019, Pages 37-40
World Neurosurgery

Technical Note
Use of Artemis Neuro Evacuation Device in Resection of Pituitary Adenoma: Initial Technical Note

https://doi.org/10.1016/j.wneu.2019.02.113Get rights and content

Background

Endoscopic transsphenoidal resection has become the primary approach for resection of pituitary macroadenomas. However, challenges such as narrow sinuses, dense tumor consistency, and invasion of surrounding structures exist.

Methods

We report a case in which the Artemis Neuro Evacuation device was used to endonasally remove a pituitary macroadenoma with suprasellar and parasellar extensions. The methodology and technical aspects of this device's novel use are illustrated.

Results

The long and narrow wand of the Artemis system allowed the operators to navigate through patient's narrow sinuses. Despite a dense tumor that did not come easily into a suction, the entire tumor debulking procedure lasted <10 minutes with the preservation of an intact arachnoid membrane using the Artemis. No perioperative complication was encountered, and the patient's neurologic deficits resolved.

Conclusions

To the authors' knowledge, this represents the first reported case of the Artemis system's utility in the treatment of pituitary tumor beyond cranial hematoma and hemorrhage.

Introduction

According to the Surveillance, Epidemiology, and End Results database, the annual incidence of pituitary adenoma in the United States is 2.7 per 100,000 and continues to increase.1 Although pituitary adenoma can be managed conservatively, surgical debulking provides the promptest relief from tumor's local mass and systemic hormonal effects.2, 3, 4 Transsphenoidal surgery now accounts for the majority of the surgical approaches and is a first-line treatment for nonfunctional pituitary adenomas.2, 4, 5 However, large adenomas invading paranasal and suprasellar cavities often require a more aggressive removal of nasal structures to achieve gross total resection, predisposing to complications such as cerebrospinal fluid (CSF) leakage and neurovascular damage.6 The Artemis Neuro Evacuation device (Penumbra, Alameda, California, USA) has been previously used to aspirate intraparenchymal hemorrhages and abscesses,7, 8, 9 but its therapeutic value in treating pituitary adenoma has not been investigated. This case report presents a novel use of the Artemis/Apollo system in the minimally invasive evacuation of a large pituitary adenoma with suprasellar and parasellar extensions. The aim is to describe its methodology and technical aspects of the case.

Section snippets

History and Examination

A 49-year-old woman with a history of diabetes, hypertension, hypothyroidism, and obstructive sleep apnea presented with double vision during reading only and blurry vision for more than a year. She demonstrated a bilateral temporal hemianopsia and color disturbance in her periphery vision with graying of the red color. A magnetic resonance imaging scan of her head revealed an enhancing mass measuring 2.5 × 2 × 1.8 cm, centered in the sella with suprasellar extension and compression of the

Discussion

Approximately 95% of all pituitary adenoma surgical cases can be managed with the transsphenoidal approach, which can be achieved endoscopically or microscopically.2 Despite our patient's relatively small sella, we were able to access the tissues along the diaphragm without further bony exposure using the Penumbra Artemis. The Artemis is a single-use straight tip that is marketed in several dimensions with diameters from 1.5–2.8 mm and length of 26 or 27 cm. The handle of the wand is connected

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