Cryoablation has been used by neurosurgeons in the past and is currently being used by other disciplines to treat kidney cancer, skin lesions, and cardiac conduction defects. Because the currently available cryogenic probes can safely create large lesions and the lesion generation (in the form of ice-ball) can be monitored on intraoperative CT images, cryoablation was used to treat large tumors in and around the sella. In this paper, the author describes a technique to perform this procedure. Three large tumors in 3 patients were treated with this method. Age of the patients was 26–58 years with a male/female ratio of 2/1. Patient 1 had a non-secreting pituitary adenoma (measuring 8 × 8 cm) and presented with long-standing total visual loss in both eyes, severe headache, and seizures. She had previous resection and radiation therapy. Patient 2 had prolactinomas (measuring 5.1 × 4.6 cm) and presented with progressive loss of vision and diplopia. Patient 3 had recurrent craniopharyngioma (measuring 7.2 × 5 cm) with prior treatment with resection radiation and frequent drainage of the cyst. He presented with headache and progressive worsening of his vision. The procedure was done on the CT table with intraoperative scans, using Patil stereotactic frame and argon cryoablation probe (Healthtronics). 3-D images were used to plan targets and trajectories. The probe was placed at the target via a trans-nasal trans-sphenoidal route. One to 3 lesions measuring 2.5–3 cm in diameter were made to ablate the tumor. Ice-ball formation was monitored live on CT images. There is no complication. One patient had near-complete resolution of the tumor, two had partial resolution of their tumors, and all had resolution of their presenting symptoms at follow-up of 3–24 months (median 6 months). In one patient, symptoms reoccurred due to the formation of new tumor masses. Cryoablation of intracranial tumors and can be done safely and effectively. Live monitoring of lesion generation using CT imaging is a major advantage of this technique.

中文翻译：

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术中 CT 扫描对鞍区大肿瘤进行立体定向冷冻消融术——技术说明

冷冻消融过去曾被神经外科医生使用，目前正被其他学科用于治疗肾癌、皮肤病变和心脏传导缺陷。由于目前可用的低温探针可以安全地产生大的病变，并且可以在术中 CT 图像上监测病变的产生（以冰球的形式），因此冷冻消融用于治疗蝶鞍内和周围的大肿瘤。在本文中，作者描述了一种执行此过程的技术。用这种方法治疗了 3 名患者的 3 个大肿瘤。患者年龄为 26-58 岁，男女比例为 2/1。患者 1 患有非分泌性垂体腺瘤（尺寸为 8 × 8 厘米），双眼长期完全视力丧失、严重头痛和癫痫发作。她之前接受过切除术和放射治疗。患者 2 患有泌乳素瘤（尺寸为 5.1 × 4.6 cm）并表现为进行性视力丧失和复视。患者 3 患有复发性颅咽管瘤（尺寸为 7.2 × 5 厘米），之前接受过切除放射治疗和囊肿频繁引流。他表现为头痛和视力逐渐恶化。该程序是在 CT 台上进行的，并使用 Patil 立体定向框架和氩冷冻消融探针 (Healthtronics) 进行术中扫描。3-D 图像用于规划目标和轨迹。探针通过经鼻经蝶骨途径放置在目标处。制作 1 到 3 个直径为 2.5-3 厘米的病灶以消融肿瘤。在 CT 图像上实时监测冰球的形成。没有并发症。一名患者的肿瘤几乎完全消退，两名患者的肿瘤部分消退，并且在 3-24 个月（中位数为 6 个月）的随访中，所有患者的症状都得到了缓解。在一名患者中，由于形成新的肿瘤块，症状再次出现。颅内肿瘤的冷冻消融术可以安全有效地进行。使用 CT 成像实时监测病灶生成是该技术的主要优势。