Article
The value of the neuronavigation in neuroendoscopic procedures – a prospective evaluation
Der Wert der Neuronavigation bei neuroendoskopischen Verfahren – eine prospektive Studie
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Published: | May 8, 2006 |
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Objective: In occlusive hydrocephalus, intracranial cysts and some ventricular tumours, endoscopic procedures have replaced shunt operations and microsurgery. There is an ongoing discussion, if neuronavigation should routinely accompany neuroendoscopy or if its use should be limited to selected cases. In this prospective clinical series, the role of neuronavigation during intracranial endoscopic procedures was investigated.
Methods: In 126 consecutive endoscopic procedures (endoscopic third ventriculostomy [ETV] n=65, biopsy / resection of intra- or periventricular tumour n=36, cyst fenestration in non-tumorous cystic lesions n=24, hematoma removal n=2), performed in 122 patients, neuronavigation was made available for the surgeon. After operation and review of the video tape, the surgeon had to categorize the role of neuronavigation: not beneficial; beneficial, but not essential for realization of the operation; essential.
Results: Overall, neuronavigation was of value in more than 50% of the operations, but this value depended on the type of the endoscopic procedure. Neuronavigation was beneficial, but not essential in 14 ETVs (27%), 10 tumour biopsies / resections (53%) and 5 cystostomies (33%). Neuronavigation was essential to accomplish surgery in 1 ETV (2%), 4 tumour biopsies / resections (21%) and 10 fenestrations of cystic lesions (67%). Neuronavigation was not needed / not used in 37 of 52 ETVs (71%), and in 4 of 19 endoscopic operations of intraventricular tumours (21%).
Conclusions: For ETV, neuronavigation mostly is not required. In the majority of the remaining endoscopic procedures (85%) however, neuronavigation is at least beneficial for the surgeon. This finding suggests integrating neuronavigation into the operative routine in endoscopic tumour operations and cyst fenestrations.