was read the article
array:23 [ "pii" => "S2529849622000430" "issn" => "25298496" "doi" => "10.1016/j.neucie.2021.04.008" "estado" => "S300" "fechaPublicacion" => "2022-09-01" "aid" => "506" "copyright" => "Sociedad Española de Neurocirugía" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2022;33:219-26" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S2529849621000496" "issn" => "25298496" "doi" => "10.1016/j.neucie.2021.11.001" "estado" => "S300" "fechaPublicacion" => "2022-09-01" "aid" => "508" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2022;33:227-36" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>" "titulo" => "Long-term survival of glioblastoma: A systematic analysis of literature about a case" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "227" "paginaFinal" => "236" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Glioblastomas de larga supervivencia: un análisis sistemático de la literatura a propósito de un caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 980 "Ancho" => 1305 "Tamanyo" => 328764 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Current anatomic pathological study from the paraffin block obtained during tumour resection in 1997. (A) Haematoxylin and eosin staining showing endothelial cell hyperplasia and the formation of abnormal vascular structures with multiple lumens simulating renal glomeruli. (B) Arrangement of tumour cells in pseudoepalisade around irregular foci of necrosis. (C) Immunohistochemical staining for IDH1 positive tumour cells. (D) Low power immunohistochemical staining for Ki-67 reflecting a positivity of approximately 5%.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis Germán González Bonet, Claudio Piqueras-Sánchez, Esther Roselló-Sastre, Ricardo Broseta-Torres, Ramón de las Peñas" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Luis Germán" "apellidos" => "González Bonet" ] 1 => array:2 [ "nombre" => "Claudio" "apellidos" => "Piqueras-Sánchez" ] 2 => array:2 [ "nombre" => "Esther" "apellidos" => "Roselló-Sastre" ] 3 => array:2 [ "nombre" => "Ricardo" "apellidos" => "Broseta-Torres" ] 4 => array:2 [ "nombre" => "Ramón" "apellidos" => "de las Peñas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1130147321000567" "doi" => "10.1016/j.neucir.2021.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147321000567?idApp=UINPBA00004B" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849621000496?idApp=UINPBA00004B" "url" => "/25298496/0000003300000005/v1_202209070704/S2529849621000496/v1_202209070704/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S2529849622000429" "issn" => "25298496" "doi" => "10.1016/j.neucie.2021.03.002" "estado" => "S300" "fechaPublicacion" => "2022-09-01" "aid" => "494" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Neurocirugia. 2022;33:209-18" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>" "titulo" => "Need for head and neck repositioning to restore electrophysiological signal changes at positioning for cervical myelopathy surgery" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "209" "paginaFinal" => "218" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Necesidad de recolocación de la cabeza y el cuello para revertir alteraciones neurofisiológicas intraoperatorias en el posicionamiento para cirugía de mielopatía cervical" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1543 "Ancho" => 2508 "Tamanyo" => 462086 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">An illustrative example of head repositioning resulting in partial restoration of SEP. A 62-year-old man presenting with spastic quadriparesis and gait impairment showed multilevel stenosis and cord compression preferentially affecting the C5C6 level. The patient was scheduled for laminectomy. When the patient was positioned prone, upper limbs’ SEP dropped<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>50% bilaterally compared to baseline values (only right median SEP is shown in the figure). The neck was promptly repositioned (slightly extended) and SEP signals progressively improved within minutes, yet not to normal baseline values (−21.7% in amplitude; the green line is the baseline waveform). This amplitude decrease was considered safe and the intervention was then performed. The patient did not exhibit postoperative neurological worsening. Six months after surgery, magnetic resonance images showed adequate cord decompression with remaining intramedullary T2 signal and myelomalacia. Although four-limb motor function markedly improved, gait disturbances remain after 1.5 years of follow up.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro David Delgado-López, Antonio Montalvo-Afonso, Elena Araus-Galdós, Francisco Isidro-Mesa, Javier Martín-Alonso, Vicente Martín-Velasco, José Manuel Castilla-Díez, Antonio Rodríguez-Salazar" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Pedro David" "apellidos" => "Delgado-López" ] 1 => array:2 [ "nombre" => "Antonio" "apellidos" => "Montalvo-Afonso" ] 2 => array:2 [ "nombre" => "Elena" "apellidos" => "Araus-Galdós" ] 3 => array:2 [ "nombre" => "Francisco" "apellidos" => "Isidro-Mesa" ] 4 => array:2 [ "nombre" => "Javier" "apellidos" => "Martín-Alonso" ] 5 => array:2 [ "nombre" => "Vicente" "apellidos" => "Martín-Velasco" ] 6 => array:2 [ "nombre" => "José Manuel" "apellidos" => "Castilla-Díez" ] 7 => array:2 [ "nombre" => "Antonio" "apellidos" => "Rodríguez-Salazar" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849622000429?idApp=UINPBA00004B" "url" => "/25298496/0000003300000005/v1_202209070704/S2529849622000429/v1_202209070704/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Research</span>" "titulo" => "Preoperative 3D volume reconstruction of the posterior wall of the sphenoid sinus with Horos: A free, simple and reliable tool in endoscopic endonasal trans-sphenoidal surgery" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "219" "paginaFinal" => "226" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francesco Paglia, Alessandro Caporlingua, Daniele Armocida, Francesca Rizzo, Antonio Santoro, Luca D’angelo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Francesco" "apellidos" => "Paglia" ] 1 => array:2 [ "nombre" => "Alessandro" "apellidos" => "Caporlingua" ] 2 => array:4 [ "nombre" => "Daniele" "apellidos" => "Armocida" "email" => array:1 [ 0 => "danielearmocida@yahoo.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:2 [ "nombre" => "Francesca" "apellidos" => "Rizzo" ] 4 => array:2 [ "nombre" => "Antonio" "apellidos" => "Santoro" ] 5 => array:2 [ "nombre" => "Luca" "apellidos" => "D’angelo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Human Neurosciences Department, Neurosurgery Division, “Sapienza” University, Italy" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción volumétrica 3D preoperatoria de la pared posterior del seno esfenoidal con Horos: una herramienta gratuita, sencilla y fiable en la cirugía endoscópica endonasal transesfenoidal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1841 "Ancho" => 3000 "Tamanyo" => 813951 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Exemplary case n.2 showing the comparison between the radiological and surgical anatomy of the posterior wall of the sphenoid sinus in a patient operated on for an ACTH microadenoma.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Neoplasms involving the sella turcica are among the most common intracranial lesions.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> Adenoma is the most common lesion of the sellar region.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1–3</span></a> Surgical gross total resection (GTR) is the mainstay of treatment in patients presenting a sellar mass and symptomatic hormonal abnormalities in those who have visual impairment due to the displacement of visual pathways by the tumor and/or other mass effect clinical manifestations or cases featuring radiologically documented growth of the lesion. The endonasal paraseptal trans-sphenoidal endoscopic corridor is a relatively simple and safe surgical route and is widely adopted to approach sellar neoplasms.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The sphenoid sinus (SS) is enclosed within the sphenoid body involving a number of different structures, which makes it difficult to approach it due to its deep anatomical location. The inner wall of the SS and its septations present an elevated degree of inter-individual anatomical variability.</p><p id="par0015" class="elsevierStylePara elsevierViewall">It surrounded by neurovascular structures such as pituitary gland (PG), internal carotid artery (ICA), optic nerve (ON), maxillary nerve and pterygoid nerve. Therefore, the knowledge of the anatomical variations of these structures is fundamental to avoid careless manipulation, which can result in serious complications with poor prognosis.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Therefore, recognition of the main endoscopic anatomical landmarks is paramount to achieving adequate exposure sella, which is recommended to increase the likelihood of a GTR of any pituitary lesion.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Dedicated magnetic resonance imaging (MRI) of the pituitary is the radiological study of choice for evaluating PG and central skull region. Computed tomography (CT) scan is complementary and allows for identification of calcification and adjacent variations of the osseous skull base.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Preoperative planning with brain MRI and 3D head CT scan with the reconstruction of the maxillofacial skeleton, nasal, and paranasal sinuses is useful for defining sella turcica conformation and distribution of sphenoidal septations, posterior ethmoidal cells, and their correlation with the sella floor and surrounding structures. Intraoperative neuronavigation might be used as an adjunct to an even safer intraoperative definition of sellar floor boundaries; however, its advantages are reduced by some not negligible limitations, such as the non-continuous availability of the instrument during the procedure and the frequent loss of precision when it is used to navigate the deep paranasal sinuses.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">We present a simple, widely accessible, and free technique to preoperatively produce a 3D reconstruction of the SS using a simple open-source DICOM viewer, enabling the operator to familiarize himself with each case's unique SS and sella floor anatomy before the actual surgical procedure. We aimed to provide a useful and simple tool to treat intrasellar pathology with an easy pre-operative preparation of the case. A comparison between preoperative and intraoperative findings is provided in order to verify the reliability of the technique.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">We performed an institutional prospective study of a consecutive series of surgically treated patients suffering from radiological confirmed intra sellar surgery through an endonasal transsphenoidal endoscopic surgery (TES). Clinical files of all patients undergoing pituitary surgery through a TES approach in the Neurosurgical Unit at the University Sapienza, Rome, Italy between 2017 and 2019 were collected and scrutinized. All patients hospitalized for TES underwent pre-operative and postoperative routine blood work, including pituitary hormone levels. We selected a total of 40 patients who underwent surgery in our institution in the period ranging between January 2017 and March 2019 meeting the following inclusion criteria:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0045" class="elsevierStylePara elsevierViewall">Patients were included in the study if their pre- and post- operative MR imaging was either performed at our institution or available on the picture archiving and communication system (PACS) for review.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0050" class="elsevierStylePara elsevierViewall">Patients were included if have a harboring pituitary neoplasms with suprasellar extension and radiologically evident visual pathways displacement confirmed by imaging with pre-operative ophthalmological examination and visual field testing.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0055" class="elsevierStylePara elsevierViewall">The estimated target of the surgical procedure was the total or subtotal resection of the lesions: no biopsies were included.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0060" class="elsevierStylePara elsevierViewall">All the patients included in the study were newly diagnosed pituitary lesion at their first surgery. Operating on recurrences makes a complete difference.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0065" class="elsevierStylePara elsevierViewall">Incomplete or wrong data on clinical, radiological and surgical records and/or lost to follow-up, were excluded.</p></li></ul></p><p id="par0070" class="elsevierStylePara elsevierViewall">For all the included patients we recorded Age, Type of lesion, the activity expressed as Secretive or Not Secretive Tumor, post-operative complications (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Radiological investigations</span><p id="par0075" class="elsevierStylePara elsevierViewall">Brain MRI with Gadolinium T1-weighted and Time-of-Flight MRA sequences were performed in all patients along with a thin slice head and maxillofacial CT scan. Radiological parameters including:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">1)</span><p id="par0080" class="elsevierStylePara elsevierViewall">the distance between the prominence of the cavernous segment of the ICAs in SS (identified as inter-cICA distance);</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">2)</span><p id="par0085" class="elsevierStylePara elsevierViewall">the pattern of septation of the sphenoid sinus (number of septation and point of insertion on the posterior sphenoid wall);</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">3)</span><p id="par0090" class="elsevierStylePara elsevierViewall">sphenoid sinus pneumatization extent (pre-sellar, sellar, post-sellar, and conchal) were measured or registered.</p></li></ul></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Creation and analysis of a 3D model of the posterior wall of the sphenoid sinus</span><p id="par0095" class="elsevierStylePara elsevierViewall">A 3D volume rendering of the sphenoid sinus was obtained for each patient from a thin slice head and maxilla-facial CT scan using an open-source DICOM viewer, Horos 3.3.2 for OS X (Nimble Co LLC d/b/a Purview in Annapolis, MD USA). 3D models of the posterior wall of the sphenoid sinus were obtained using the graphic processing unit (GPU) engine, 16bit color lookup table (CLUT) editor, and the crop function. The resulting model was cubic with an anterior face corresponding to a plane slightly posterior to the rostrum sphenoidalis, two lateral faces lied just lateral to the anterior clinoid process bilaterally, the cephalad face was placed just above and parallel to the planum sphenoidalis, and the inferior face just posterior to both posterior clinoid processes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The 3D models obtained preoperatively were examined preoperatively by three senior neurosurgeons, the senior group, and three residents, the junior group. Both groups were involved in the actual surgical endoscopic procedure. Anatomical landmarks crucial for the correct definition of the boundaries of the sella including sellar prominence (SP), clival recess (CR), planum sphenoidalis (PS), right and left ICA prominence (RIP, LIP), right and left optic prominences (ROP, LOP), right and left medial (RMO, LMO) and lateral (RLO, LLO) optocarotid recesses and tumor prominence (TP). Video registration and intraoperative neuronavigation of each endoscopic procedure enabled us to compare the 3D model with intraoperative findings to verify the reliability of the landmarks preoperatively recognized in the 3D model (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">For each patient, a 3D volume rendering of the sphenoid sinus was obtained from a thin slice head and maxilla-facial CT scan using a free, open-source code DICOM viewer software called Horos 3.3.2 for OS X (Nimble Co LLC d/b/a Purview in Annapolis, MD USA) using a thin slice head CT scan sequence. The best renderings3D models of the posterior wall of the sphenoid sinus were obtained using the graphic processing unit (GPU) engine, 16bit color lookup table (CLUT) editor, and the crop function to create a cubic cropped model. The resulting model was cubic. The latter presented with an anterior square face corresponding to a plane slightly posterior to the rostrum sphenoidalis, two lateral faces placed lied just lateral to the anterior clinoid process bilaterally, one the superior cephalad square face was placed just above and parallel to the planum sphenoidalis superiorly and in-line with the planum sphenoidalis. The inferior face corresponds with the sphenoid sinus floor, and a posterior face is placed just posterior to both posterior clinoid processes (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The 3D models were obtained preoperatively whereas examined preoperatively by three senior neurosurgeons, the senior group, s and three residents, the junior group. Both groups were involved in the actual surgical endoscopic procedure. Anatomical landmarks crucial for the correct definition of the boundaries of the sella including sellar prominence (SP), clival recess (CR), planum sphenoidalis (PS), right and left ICA prominence (RIP, LIP), right and left optic prominences (ROP, LOP), right and left medial (RMO, LMO) and lateral (RLO, LLO) optocarotid recesses and tumor prominence (TP). Video registration and intraoperative neuronavigation of each endoscopic procedure enabled us to compare the 3D model with intraoperative findings to verify the reliability of the landmarks preoperatively recognized in the 3D model (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2 and 3</a>).</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">Among all patients undergound pituitary surgery through an endonasal transsphenoidal endoscopic approach in the Neurosurgical Unit at the University Sapienza, Rome, Italy between 2017 and 2019, forty patients were included in this study. Demographics for this cohort are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. There were nineteen pituitary macro-adenomas and twenty-one pituitary micro-adenomas. The two group of observers (senior and junior group) analyzed 3D models from all the fourty patients and were asked to identify and note down the recognizable anatomical landmarks of the posterior wall of the sphenoid sinus previously described. The frequency of overall positive interobservers agreement (i.e. all the observers were able to identify the landmark) in recognizing each anatomical structure was calculated for the senior and junior group and both combined, for micro/macro adenoma phenotypes and for each single patient. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the results of the two groups, where is showed the rate (%) of unequivocal landmarks identification among observers (each of the observer was able to identify the anatomical structure). We report the landmark identification-rate for senior neurosurgeons, residents and both of them. For SP, CR, PS, LIP ROP, LOP all of the observers were able to recognize the anatomical structure at a rate ranging from 80 to 98%, 28 to 60% and 25 to 58% for expert (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3), inexpert (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) and the entire group of observers (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6), respectively (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). For RLO, LLO, RMO, LMO, TP the rate was consistently lower for each of the three categories of examinators (23–43%, 13–23% and 5–8%, respectively). Senior neurosurgeons have obviously identified the anatomical landmarks with a higher rate of frequency than the trainees. However, the analysis of the data shows that both observation groups presented a lower recognition rate of the following parameters: right and left medial (RMO, LMO) and lateral (RLO, LLO) optocarotid recesses and tumor prominence (TP). Accordingly to our experience, the sellar prominence (SP), clival recess (CR), planum sphenoidalis (PS), right and left ICA prominence (RIP, LIP), right and left optic prominences (ROP, LOP) represent the main anatomical landmarks to be recognized during transphenoidal surgery immediately before the opening of the sellar floor. These results highlight in part the greater propensity to recognize these parameters by the operators involved in the study but at the same time confirm that the 3D reconstruction model reliably reproduces the inner wall of the sphenoid sinus. Finally, all the observers presented difficulties in identification of the tumor prominence (8% rate of unequivocal recognition) and this is only partly due to the resolution limits of the 3D model as this parameter is difficult to recognize both during live surgery and from intraoperative videos evaluation. Therefore, the intraoperative neuronavigation system could make up for this limit by allowing the recognition of tumor prominence during surgery in order to perform a targeted and selective opening of the sellar floor.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">In <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>, the distribution of overall positive agreement of the 12 anatomical landmarks among different patients in micro and macroadenomas are shown. No unequivocal agreement of any anatomical structure was obtained in 6 (31.6%) patients with macroadenoma, but in one case (5.3%) 9 landmarks were identified by all the observer (senior and residents). A median higher rate can be detected for microadenomas (33% vs 25%) but a relevant role of each single case is evident (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The Median rate frequency (%) of unambiguous identification in each patient (12 anatomical structures) among all observers (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6) was higher in microademonas (33) than macroadenomas (25) which were also related to a higher rate of ambiguous identification (75). These results are probably related to the greater distortion of the normal anatomy determined by macroadenomas such as to make the recognition of these parameters more difficult. Therefore, the intraoperative neuronavigation would improve the recognition of the anatomical landmarks in order to achieve an adequate opening of sellar floor.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">TES is considered the standard surgical approach for removing sellar neoplasms.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a> To obtain an adequate exposure of the sella, knowledge of the main endoscopic anatomical landmarks of the SS's posterior wall is fundamental.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">7–9</span></a> Unfortunately, these anatomical landmarks, along with the bony anatomy of the sella and posterior wall of the SS, present a certain degree of interindividual variability.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">10–12</span></a> This variability might lead to intraoperative difficulties in achieving adequate exposure of the skull base structures and safely recognizing the projection of critical neurovascular structures. Moreover, adequate exposure of the sella is crucial to achieving the best result in pituitary tumor resection.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">6–13</span></a> Technology had come to aid with developing increasingly powerful endoscopic cameras and optics and the diffusion of neuronavigation systems to verify the correspondence between intraoperative findings and preoperative imaging intraoperatively. However, the shortcomings of these technological advancements are not to be neglected. Despite being widely available, not all neurosurgeons dispose of a neuronavigation system; secondly, we observed that neuronavigation applied to paranasal sinuses is often, to the best of our experience, hampered by a millimetric reduction inaccuracy. This kind of drop in accuracy, event tough of millimetric proportion, in the setting of TES usually results in a dramatic reduction in this technique's reliability.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Preoperative thin slice craniofacial CT scan in patients undergoing pituitary surgery has been extremely useful as it enables evaluating both bone and mucosa of the nasal and paranasal sinuses.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> Furthermore, the use of a preoperative 3D reconstruction of the SS and sella turcica has already been described in the literature. Wang et al.,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> published a retrospective series of patients undergoing resection of pituitary neoplasms through a microsurgically obtained transsphenoidal corridor. Using Mimics 15.0 software (Materialise Corporation, Leuven, Belgium), 3D reconstructions of the SS based on thin slice head CT scans allowed to analyze the morphology of the sella turcica, tumoral diameter and volume, SS septations, Onodi cells and their correlation with the sella floor and cICA protrusions. The distance between cICA protrusions and between each cICA and the midline were also registered. No actual 3D images of the SS were provided in their paper, and Mimics is not an open-source software readily available for use. Moreover, this model was applied not for endoscopic procedures but microsurgical transsphenoidal exposure of the sella.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Mavar-Haramija et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">16</span></a> reported a 3D model of cadaveric heads’ skull base before and after endoscopic endonasal transsphenoidal extended approaches skull base. Pre and post-dissection head CT scan DICOM images were exported and elaborated into three different software (Amira® 5.2; PDF3DReportGen and Adobe Acrobat XI Pro) before be available for visualization as 3D-PDF documents on a standard Acrobat Reader platform. Furthermore, elaboration of the 3D model required knowledge of JavaScript programming language. Quantification of exposure and degree of freedom was also performed to compare different surgical skull base approaches. In our opinion, such a 3D model would fit perfectly in a neurosurgical training environment rather than an adjoint tool to be used daily for actual neurosurgical endonasal endoscopic procedures.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Wu et al.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">17</span></a> collected data from thin slice head CT scan of 111 patients measuring the distance between the nasal spine and the optic canal, medial edge of the foramen lacerum, the midpoint of the tuberculum sellae, posterior-inferior midpoint of sellar floor along with the angle formed by the line connecting the latter to the nasal spine and a line projected from the nasal spine and the posterior midpoint of the hard palate. The authors found an inter-individual consistency of these measurements and therefore claimed that the latter might help neurosurgeons reduce the risk of complications during endoscopic endonasal sphenoidotomy. Unfortunately, they did not report how this protocol was applied and changed their routine surgical activity.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Similar to our technique, Göçmez et al.,<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">18</span></a> elaborated a 3D model of the SS from 50 thin slice head CT scan performed for other reasons rather than pituitary surgery to study anatomy and interindividual anatomical variability of the sphenoid Ostium. The authors speculated that such preoperative assessment might help surgeons achieve a better orientation during endoscopic paranasal sinus dissections.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The elaboration of our 3D model of the SS did not require any particular technical skill. It was performed with a free and open-source DICOM viewer using CT scan images. It allowed us to preoperatively build up a three-dimensional, freely explorable and customizable, patient-specific model of the sphenoid, which was revealed to be fairly close to that visualized during the actual endoscopic procedure.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Preoperative recognition of anatomical landmarks with this 3D model and the intraoperative neuronavigation allowed us to reduce timing and, at the same time, to perform safer and more accurate TESs. This technique was never described in the literature to the best of our knowledge.</p><p id="par0150" class="elsevierStylePara elsevierViewall">This study's main limitation is that the correlation between the 3D model and the actual intraoperative findings was based on a subjective evaluation and was conducted by the same subjects involved in elaborating the 3D model.</p><p id="par0155" class="elsevierStylePara elsevierViewall">This study's satisfactory preliminary results encourage us to develop a new model of endoscopic transsphenoidal training for residents in neurosurgery interested in endoscopic skull base surgery.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Moreover, the development of 3D printing models could be introduced to increase the level of recognition of anatomical landmarks and improve specific skills of the endoscopic surgery through hand-on exercitations.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusion</span><p id="par0165" class="elsevierStylePara elsevierViewall">With this paper we want to show a simple and safety tool for pre-operative planning useful for TES. The potential of this kind of preoperative planning using free, open-source 3D technologies might be exploited not only for the safety of patient care but also in the setting of training for both neurosurgeons with limited experience with TES and residents in neurosurgery who need to familiarize with those endoscopic anatomical landmarks crucial to approach the sella turcica safely. The use of a preoperative 3D imaging is not in itself a novelty in the literature, however the fact that a simple tool obtained with a free-source software like Horos can represent a considerable help in surgical practice without resorting to the use of more complex software and expensive represents the real utility of this work.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">This study was no funded by any association.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Informed consent</span><p id="par0175" class="elsevierStylePara elsevierViewall">Informed consent was obtained from all individual participants included in the study.</p><p id="par0180" class="elsevierStylePara elsevierViewall">The patient has consented to the submission of this review article to the journal.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1767519" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1553932" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1767518" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1553933" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Radiological investigations" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Creation and analysis of a 3D model of the posterior wall of the sphenoid sinus" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0045" "titulo" => "Informed consent" ] 11 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-01-07" "fechaAceptado" => "2021-04-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1553932" "palabras" => array:6 [ 0 => "Neurosurgery" 1 => "Pituitary gland" 2 => "Transphenoidal approach" 3 => "Brain tumor" 4 => "Neuroendoscopy" 5 => "Intrasellar region" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1553933" "palabras" => array:6 [ 0 => "Neurocirugía" 1 => "Glándula pituitaria" 2 => "Abordaje transesfenoidal" 3 => "Tumor cerebral" 4 => "Neuroendoscopia" 5 => "Región intraselar" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The purpose of the study was to create computer-aided design models of the sphenoid sinus with a free-source software in order to perform a preoperative planning during trans-sphenoidal endoscopic surgery (TES) and clarify the three-dimensional anatomical features of the sphenoid sinus and its surrounding structures.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">For each patient a 3D volume rendering of the sphenoid sinus was obtained from a thin slice head and maxilla-facial CT scan using a free-source DICOM viewer. The 3D models obtained preoperatively were examined preoperatively by six neurosurgeons in order to identify the boundaries of the sella.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">For the main anatomical landmark, all of the observers were able to recognize the anatomical structure at a rate ranging from 80 to 98%, 28 to 60% and 25 to 58% for expert (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3), inexpert (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) and the entire group of observers (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6), respectively. The analysis of the data shows that both observation groups presented a lower recognition rate of the following parameters: right and left medial and lateral optocarotid recesses and tumor prominence, however, the sellar prominence, clival recess, planum sphenoidalis, right and left ICA prominence, right and left optic prominences represent the main anatomical landmarks to be recognized during TES immediately before the opening of the sellar floor.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The use of a preoperative 3D imaging is not in itself a novelty in the literature, however the fact that a simple tool obtained with a free-source software like Horos can represent a considerable help in surgical practice without resorting to the use of more complex software and expensive represents the real utility of this work.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo del estudio es crear modelos de diseño asistido por ordenador del seno esfenoidal con <span class="elsevierStyleItalic">software</span> de código abierto para realizar la planificación preoperatoria durante la cirugía transesfenoidal endoscópica (TES) y dilucidar las características anatómicas tridimensionales del seno esfenoidal y las estructuras que lo rodean.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Para cada paciente, se obtuvo una representación volumétrica en 3D del seno esfenoidal, a partir de una tomografía computarizada maxilofacial de corte fino utilizando un visor DICOM de fuente libre. Los modelos 3D obtenidos antes de la cirugía fueron revisados por seis neurocirujanos para identificar los límites de la silla turca.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Para el principal punto de referencia anatómico, todos los observadores fueron capaces de reconocer la estructura anatómica en un rango de 80 a 98%, 28 a 60% y 25 a 58% para los experimentados (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3), los inexpertos (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) y todo el grupo de observadores (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6), respectivamente. El análisis de los datos muestra que ambos grupos de observación presentaron una tasa de reconocimiento menor de los siguientes parámetros: recesos optocarotídeos medial y lateral izquierdo y prominencia tumoral, sin embargo, prominencia selar, receso clival, plano esfenoidal, prominencia ICA derecha e izquierda. Las prominencias ópticas derecha e izquierda representan los principales puntos de referencia anatómicos que deben reconocerse durante la TES inmediatamente antes de la apertura del suelo selar.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El uso de una imagen 3D preoperatoria no es en sí mismo una novedad en la literatura, sin embargo, el hecho de que una simple herramienta obtenida con un <span class="elsevierStyleItalic">software</span> de código abierto como Horos pueda representar una importante ayuda en la práctica quirúrgica, sin tener que recurrir al uso de un <span class="elsevierStyleItalic">software</span> más complejo y costoso, representa la verdadera utilidad de este trabajo.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1517 "Ancho" => 3000 "Tamanyo" => 518665 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Step-by-step creation of a 3D model of the posterior wall of the sphenoid sinus performed prior to an endoscopic endonasal transsphenoidal procedures for a GH secreting macroadenoma. (A) Thin slice head CT-scan images were 3D rendered with Horos 3.3.2 for OS X (Nimble Co LLC d/b/a Purview in Annapolis, MD USA). The 16bit color look up table (CLUT) editor was used to create two different curves to highlight skin and bone with the most realistic color possibly achievable. Having a similar density on CT images, skin and mucosa presented the same color. (B) Using the crop function the model was cropped along a sagittal plane passing through the midline enabling to clearly recognize the (ST) sella turcica, (RS) rostrum sphenoidalis and (SS) sphenoid sinus. (C) An additional coronal cropping plane was fashioned just posterior and parallel to the rostrum sphenoidalis. (D) The sagittal cropping plane was adjusted in order to preserve the anatomy in a plane passing just lateral to the anterior clinoid process (ACP) so that the optic canals (OC) and superior orbital fissures (SOF) were clearly visible bilaterally. The model was finally oriented in order to simulate a projection which was as close as possible to that obtained during the actual endoscopic procedure. The main anatomical landmarks of the posterior wall of the sphenoid sinus were subsequently recognized. In this particular case it was possible to differentiate the following landmarks following a craniocaudal order: planum sphenoidalis (PS), optic protuberances (OP), middle and lateral opto-carotid recesses (MOCR and LOCR), tuberculum sellae (TS), carotid protuberances (CP), tumor (t), sella turcica (ST), clival recess (CR).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 965 "Ancho" => 3000 "Tamanyo" => 305142 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">exemplary case n.1 showing the comparison between the radiological and surgical anatomy of the posterior wall of the sphenoid sinus in a patient operated on for a GH secreting microadenoma.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1841 "Ancho" => 3000 "Tamanyo" => 813951 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Exemplary case n.2 showing the comparison between the radiological and surgical anatomy of the posterior wall of the sphenoid sinus in a patient operated on for an ACTH microadenoma.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1431 "Ancho" => 1500 "Tamanyo" => 100310 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Distribution of overall positive agreement of the 12 anatomical landmarks among different patients in micro and macroadenomas are shown.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>40 patients \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>23–57.5%Female <span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>17–42.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Average 52.3 yo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Size \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Macroadenoma<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19Microadenoma<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Activity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Secretory<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>21–52.5%Not secretory<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19–47.5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GH<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9/21; 42.9%ACTH<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8/21; 38.1%PRL<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4/21; 19% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Post-operative complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypopituitarism<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0/40Hypotioidism<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6/40Diabetes insipidus<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3/40Fistula<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9/40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Patient's demographics.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CR \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">PS \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RIP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LIP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ROP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LOP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RLO \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LLO \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RMO \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LMO \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TP \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">total \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Senior neurosurgeons (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Residents (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="14" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">All observers (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">50% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Rate (%) of unequivocal landmarks identification among observers (each of the observer was able to identify the anatomical structure).</p>" ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Unambiguous identification: all of the observes were able to identify the anatomical structure. Ambiguous identification: at least one observer missed the identification of the anatomical structure. No identification: none of the observers was able to identify the anatomical structure.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Unambiguous identification \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Ambiguous identification \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No identification \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Macroadenoma (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 [0–75] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 [25–100] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 [0–33] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Microadenoma (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 [8–67] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58 [33–92] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 [0–25] \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total cases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 [0–75] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">67 [25–100] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 [0–33] \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Median [minimum–maximum] rate frequency (%) of different identification agreement in each patient (12 anatomical structures) among all observers (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>6).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sellar lesions/pathology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Bresson" 1 => "P. Herman" 2 => "M. Polivka" 3 => "S. Froelich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otc.2015.09.004" "Revista" => array:6 [ "tituloSerie" => "Otolaryngol Clin North Am" "fecha" => "2016" "volumen" => "49" "paginaInicial" => "63" "paginaFinal" => "93" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26614829" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0100" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic endonasal trans-sphenoidal approach: minimally invasive surgery for pituitary adenomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Messerer" 1 => "G. Cossu" 2 => "M. George" 3 => "R.T. Daniel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Vis Exp" "fecha" => "2018" "paginaInicial" => "55896" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0175" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neuroimaging of the pituitary gland: practical anatomy and pathology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.R. Chapman" 1 => "A. Singhal" 2 => "S. Gaddamanugu" 3 => "V. Prattipati" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rcl.2020.07.009" "Revista" => array:6 [ "tituloSerie" => "Radiol Clin North Am" "fecha" => "2020" "volumen" => "58" "paginaInicial" => "1115" "paginaFinal" => "1133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33040852" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0180" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Volumetric study of sphenoid sinuses: anatomical analysis in helical computed tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Oliveira" 1 => "M.B. Alonso" 2 => "E. de Sousa" 3 => "M.J. Tucunduva" 4 => "A. Fuziy" 5 => "A.C. Scocate" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Surg Radiol Anat" "fecha" => "2017" "volumen" => "39" "paginaInicial" => "367" "paginaFinal" => "374" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0105" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Hu" 1 => "H. Ji" 2 => "S. Zhang" 3 => "X. Hao" 4 => "B. Shen" 5 => "L. Su" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Zhonghua Yi Xue Za Zhi" "fecha" => "2015" "volumen" => "95" "paginaInicial" => "339" "paginaFinal" => "343" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26168667" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0110" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congress of neurological surgeons systematic review and evidence-based guideline on surgical techniques and technologies for the management of patients with nonfunctioning pituitary adenomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.S. Kuo" 1 => "G. Barkhoudarian" 2 => "C.J. Farrell" 3 => "M.E. Bodach" 4 => "L.M. Tumialán" 5 => "N.M. Oyesiku" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1227/NEU.0000000000001390" "Revista" => array:6 [ "tituloSerie" => "Neurosurgery" "fecha" => "2016" "volumen" => "79" "paginaInicial" => "E536" "paginaFinal" => "E538" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27635962" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0115" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic endonasal cavernous sinus surgery: an anatomic study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Alfieri" 1 => "H.D. Jho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Neurosurgery" "fecha" => "2001" "volumen" => "48" "paginaInicial" => "827" "paginaFinal" => "836" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11322443" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0120" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic endonasal transsphenoidal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Cappabianca" 1 => "L.M. Cavallo" 2 => "de Divitiis E." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1227/01.neu.0000137330.02549.0d" "Revista" => array:6 [ "tituloSerie" => "Neurosurgery" "fecha" => "2004" "volumen" => "55" "paginaInicial" => "933" "paginaFinal" => "940" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15458602" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0125" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The recesses of the sellar wall of the sphenoid sinus and their intracranial relationships" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Peris-Celda" 1 => "B. Kucukyuruk" 2 => "A. Monroy-Sosa" 3 => "T. Funaki" 4 => "R. Valentine" 5 => "A.L. Rhoton" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neurosurgery" "fecha" => "2013" "volumen" => "73" "paginaInicial" => "117" "paginaFinal" => "131" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0130" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anatomic variation of sphenoid sinus and related structures in Libyan population: CT scan study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Hewaidi" 1 => "G. Omami" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4176/080307" "Revista" => array:6 [ "tituloSerie" => "Libyan J Med" "fecha" => "2008" "volumen" => "3" "paginaInicial" => "128" "paginaFinal" => "133" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21499453" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0135" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Microsurgical anatomy of the sellar region" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.H. Renn" 1 => "A.L. Rhoton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/jns.1975.43.3.0288" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "1975" "volumen" => "43" "paginaInicial" => "288" "paginaFinal" => "298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1151464" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0140" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risky anatomic variations of sphenoid sinus for surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Unal" 1 => "G. Bademci" 2 => "Y.K. Bilgili" 3 => "F. Batay" 4 => "E. Avci" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00276-005-0073-9" "Revista" => array:6 [ "tituloSerie" => "Surg Radiol Anat" "fecha" => "2006" "volumen" => "28" "paginaInicial" => "195" "paginaFinal" => "201" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16429266" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0145" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suboptimal sphenoid and sellar exposure: a consistent finding in patients treated with repeat transsphenoidal surgery for residual endocrine-inactive macroadenomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Mattozo" 1 => "J.R. Dusick" 2 => "F. Esposito" 3 => "H. Mora" 4 => "P. Cohan" 5 => "D. Malkasian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1227/01.NEU.0000209930.88242.1C" "Revista" => array:6 [ "tituloSerie" => "Neurosurgery" "fecha" => "2006" "volumen" => "58" "paginaInicial" => "857" "paginaFinal" => "865" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16639319" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0150" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Usefulness of bone window CT images parallel to the transnasal surgical route for pituitary disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Abe" 1 => "N. Asahina" 2 => "N. Kunii" 3 => "H. Ikeda" 4 => "H. Izumiyama" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Neurochir (Wien)" "fecha" => "2003" "volumen" => "145" "paginaInicial" => "127" "paginaFinal" => "131" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0155" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging evaluation of the location and fenestration of sellar floor during endonasal transsphenoidal surgery in patients with pituitary adenomas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Wang" 1 => "Y. Qin" 2 => "D. Xiao" 3 => "Z. Wu" 4 => "L. Wei" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "World Neurosurg" "fecha" => "2018" "volumen" => "116" "paginaInicial" => "e232" "paginaFinal" => "e238" "itemHostRev" => array:3 [ "pii" => "S0016508509007501" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0160" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interactive 3D-PDF presentations for the simulation and quantification of extended endoscopic endonasal surgical approaches" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Mavar-Haramija" 1 => "A. Prats-Galino" 2 => "J.A.J. Méndez" 3 => "A. Puigdelívoll-Sánchez" 4 => "M. de Notaris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10916-015-0282-7" "Revista" => array:5 [ "tituloSerie" => "J Med Syst" "fecha" => "2015" "volumen" => "39" "paginaInicial" => "127" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26306875" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0165" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel method to locate intracranial anatomic landmarks of sella using three-dimensional computed tomography reconstruction images for endoscopic endonasal transsphenoidal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Wu" 1 => "H. Zeng" 2 => "X. Tan" 3 => "J. Ouyang" 4 => "S. Zhong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/SCS.0000000000001944" "Revista" => array:6 [ "tituloSerie" => "J Craniofac Surg" "fecha" => "2015" "volumen" => "26" "paginaInicial" => "2184" "paginaFinal" => "2186" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26468808" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0170" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of the surgical anatomy of sphenoid ostium with 3D computed tomography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Göçmez" 1 => "C. Göya" 2 => "C. Hamidi" 3 => "M. Teke" 4 => "S. Hattapoğlu" 5 => "K. Kamaşak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00276-013-1245-7" "Revista" => array:6 [ "tituloSerie" => "Surg Radiol Anat" "fecha" => "2014" "volumen" => "36" "paginaInicial" => "783" "paginaFinal" => "788" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24357354" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25298496/0000003300000005/v1_202209070704/S2529849622000430/v1_202209070704/en/main.assets" "Apartado" => array:4 [ "identificador" => "65581" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Clinical research" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25298496/0000003300000005/v1_202209070704/S2529849622000430/v1_202209070704/en/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529849622000430?idApp=UINPBA00004B" ]
Year/Month | Html | Total | |
---|---|---|---|
2023 April | 1 | 0 | 1 |
2023 March | 6 | 3 | 9 |