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

The role of image guidance for surgery of subinsular cavernoma

Navigationsgesteuerte Resektion insulärer Kavernome

Meeting Abstract

  • corresponding author U. Sure - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • W. Tirakotai - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • L. Benes - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • O. Bozinov - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • S. Heinze - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • H. Bertalanffy - Klinik für Neurochirurgie, Philipps-Universität Marburg

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 10.166

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

Published: May 8, 2006

© 2006 Sure 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: Surgical treatment of cavernomas arising below the medial insular cortex is especially challenging due to the proximity to the internal capsule and lenticulostriate arteries. We present our technique of image guidance for the surgery of such subinsular cavernomas and assess its clinical usefulness.

Methods: Between 1997 and 2005 we operated on 12 patients harboring a subinsular cavernoma with the guidance of a frameless stereotactic system (BrainLab AG, Munich, Germany). The neuronavigation was used (1) for accurate planning of the craniotomy, (2) for identification of the distal Sylvian fissure and finally (3) for finding the exact site of insular corticotomy. Image guided ultrasonography was used as an additional intraoperative imaging modality. Postoperative clinical and neuroradiological evaluations were performed in each patient.

Results: The navigation system worked properly in all 12 neurosurgical cases. Exact planning of the approach and determination of the ideal trajectory for cavernoma was possible in every case. All cavernomas were readily identified and completely removed using microsurgical technique. No surgical complication occurred, and the postoperative course was uneventful in all patients.

Conclusions: Image guidance during surgery of subinsular cavernomas provides high accuracy for lesion targeting and permits excellent anatomical orientation. Accordingly, safe exposure can be obtained due to a tailored dissection of the Sylvian fissure and minimal insular corticotomy.