gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Impact of positioning for image-guided surgery of deep-seated lesions

Einfluss der Lagerung auf die computergestützte Navigation bei tief liegenden Läsionen

Meeting Abstract

  • corresponding author D. Miller - Neurochirurgische Klinik, Standort Marburg, Universitätsklinikum Gießen und Marburg
  • O. Bozinov - Neurochirurgische Klinik, Standort Marburg, Universitätsklinikum Gießen und Marburg
  • C. Kappus - Neurochirurgische Klinik, Standort Marburg, Universitätsklinikum Gießen und Marburg
  • S. Heinze - Neurochirurgische Klinik, Standort Marburg, Universitätsklinikum Gießen und Marburg
  • H. Bertalanffy - Neurochirurgische Klinik, Standort Marburg, Universitätsklinikum Gießen und Marburg
  • U. Sure - Neurochirurgische Klinik, Standort Marburg, Universitätsklinikum Gießen und Marburg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSA.09.04

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2007/07dgnc187.shtml

Veröffentlicht: 11. April 2007

© 2007 Miller 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: Computer-assisted image guidance systems have been introduced to support approach planning for deep-seated lesions and to reduce the risk of neurological deficit for the patient. However, neuronavigation is not always accurate and may mislead. Image-guided ultrasound may detect inaccuracy and guide safe resection of deep-seated lesions.

Methods: From January 2006 to October 2006 sixteen patients underwent microsurgical resection of deep-seated lesions aided by image-guided ultrasound. Histology included eleven cavernomas, two ependymomas, one central neurocytoma, one recurrent gliosarcoma and one metastasis. In eight patients the lesion was located within the brainstem, in five cases within the deep white matter of the hemispheres and in the remaining three patients within the lateral ventricles. The medium depth from the surface measured 36.1 mm (24 - 60 mm), the minimum size of the lesion was 8 mm. Five patients were operated in a sitting position, in another five patients a lateral position was used, one patient was positioned face down and the remaining cases were operated in a supine position with one patient’s head turned 45°. In all patients preoperative planning was performed by MRI, using standard fiducials. After registration the accuracy of the navigation was checked using surface landmarks.

Results: Intraoperative ultrasound allowed the identification of all lesions. Tumour margins were well defined in 13/16 cases (81%). A significant shift at the site of the lesion was detected in 7/16 (44%) cases during the initial transdural ultrasound scan. The initial shift was seen in 4/5 patients in a lateral position and in 3/5 patients operated in a sitting position. In the majority of these cases, surface accuracy was good. The approach was subsequently planned according to sonographic images and the lesion could be localized in all cases. Perioperative morbidity included a transient decrease in neurological function in 4/8 patients with brainstem lesions and a quadrant anopia in a patient with a trigonal cavernoma.

Conclusions: The positioning of a patient is an important factor that influences the accuracy of a conventional neuronavigation system. Image-guided ultrasound may detect and compensate for inaccuracy of the navigation system. This is essential in deep-seated lesions and may increase the safety of the procedure.