Some form of guidance has always been an essential component of modern pituitary surgery. Whereas videofluoroscopy has served the purpose extremely well, frameless stereotaxy with archived computed tomography (CT) or magnetic resonance imaging (MRI) exploits the whole concept of neuronavigation to its fullest (5). Frameless stereotaxy allows precise planning of the approach with reference to lesion perimeters, anatomic landmarks such as the carotid arteries, and other potential operative hazards. Again, as mentioned, it is particularly helpful in reoperative pituitary surgery where few normal anatomic landmarks remain. In addition to encouraging early reports, citing low complication rates and good operative outcomes, there is no question that frameless stereotaxy adds greatly to surgeon comfort and confidence during the procedure. However, the surgeon using the technique must always remember that the information used is based on navigation points that are prerecorded and are only as accurate as the system allows in a perfectly set-up state. Minor movement in the pin holders results in a disastrous loss of accuracy.
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