gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

The use of image-guidance in awake craniotomy without rigid pin fixation of the head

Der Einsatz der Neuronavigation bei Wachoperationen am unifixierten Schädel

Meeting Abstract

  • corresponding author Olaf Süss - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Berlin
  • T. Picht - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Berlin
  • B. Kuehn - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Berlin
  • S. Mularski - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Berlin
  • M. Brock - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Berlin
  • T. Kombos - Neurochirurgische Klinik, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Berlin

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 08.110

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc327.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Süss et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Intraoperative neurophysiological mapping of cortical language areas in awake patients has evolved into the gold standard for the neurosurgical removal of lesions in and around the language cortex. The integration of neuronavigation into a multimodal protocol can further improve the reliability and accuracy of the operation. Unfortunately, most navigation systems available today are of limited use in awake craniotomy because they require rigid fixation of the patient’s head throughout the operation.

Methods: The present study describes the clinical use of a noninvasive, sensor-based reference system that replaces rigid pin fixation of the patient’s head during awake craniotomies. This is achieved by an additional dynamic reference frame sensor (DRF) that is noninvasively attached to the patient’s head to track movements of the unfixed cranium during the operation. The attachment technique and the resulting accuracies (FRE, TRE, PE) were investigated under clinical conditions in 13 patients undergoing awake craniotomy with intraoperative mapping of cortical language sites.

Results: The spatial information obtained by means of the DRF was used for intraoperatively updating navigation by continuously adjusting the orientation of the image planes relative to the patient’s head. The mean FRE of image data registration achieved with this technique was 1.52 mm (±0.41 mm SD). The system’s application accuracy determined as position error (PE) in target localization during different phases of the operation ranged from 0.49 to 2.06 mm. It was thus possible to overlay the results of intraoperative language mapping on the navigation images with a high degree of spatial accuracy.

Conclusions: The use of a dynamic reference frame sensor can replace uncomfortable pin fixation of the patient’s head during awake navigation-guided craniotomy. Application accuracy is not affected by the unavoidable head movements that mostly occur during the phase of language mapping. Even intraoperative repositioning of the patient (e.g. if intubation becomes necessary after completion of language mapping) is possible without impairment of navigation. This technique thus enables full exploitation of the benefits of navigation (improved preoperative planning and intraoperative orientation with the option of integrating functional imaging data and the results of language mapping) in the setting of a multimodal operative protocol established to preserve function in the area of the language cortex.