gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Catheter-guided neuronavigation to partially control intraoperative brain shift

Kathetergestützte Neuronavigation zur partiellen Kontrolle eines intraoperativ aufgetretenen “brain shifts”

Meeting Abstract

Search Medline for

  • corresponding author J.A. Hampl - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln
  • M. Löhr - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln
  • N. Klug - Klinik für Allgemeine Neurochirurgie, Klinikum der Universität zu Köln

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. DocSA.10.04

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Hampl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The intraoperative definition of tumour margins especially during the extirpation of low grade or irradiated gliomas can be quite difficult. This can be facilitated with the use of a neuronavigation system. Nevertheless, the possible development of an intraoperative brain shift is a drawback in using this technique resulting in the continuous search for new methods for better brain shift control.

Methods: This technique was developed using a BrainLab neuronavigation system. In the preoperative planning software several trajectories were placed at the tumour margins on T1-weighted MR images. Right after craniotomy ventricular catheters were placed along the predefined trajectories using the neuronavigation pointer after a 5mm dural incision has been made. The position of the placed catheters will be visualized on-line using a registered ultrasound probe. With repeated intraoperative use of the navigated ultrasound, a partial control of the developed brain shift can be achieved. With the visualization of the catheters at the resection wall, the preoperatively defined target points have been reached.

Results: 13 patients with low grade, high grade or irradiated gliomas have been operated using the described technique. In one case with a recurrent grade II glioma incidentally the accuracy of the catheter placement could be verified. In this case the recurrent tumour was located inside the previous resection cavity surrounded by a small layer of CSF. During the operation the catheter could be found exactly at this border. The use of this technique facilitated the intraoperative orientation despite the development of an intraoperative brain shift.

Conclusions: The technique of catheter-guided neuronavigation allows partial control of an intraoperatively developed brain shift. Algorithms to superimpose on-line acquired ultrasound information on preoperatively defined 3D objects have to be developed.