gms | German Medical Science

64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. - 29. Mai 2013, Düsseldorf

Intraoperative control of resection and neuronavigation during operation of skull base and orbit-associated tumors: feasibility and possible advantages of intraoperative computed tomography (iCT)

Meeting Abstract

  • Nicole A. Terpolilli - Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität München
  • Walter Rachinger - Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität München
  • Mathias Kunz - Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität München
  • Jörg-Christian Tonn - Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität München
  • Christian Schichor - Klinik und Poliklinik für Neurochirurgie, Klinikum der Universität München

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 089

doi: 10.3205/13dgnc506, urn:nbn:de:0183-13dgnc5065

Veröffentlicht: 21. Mai 2013

© 2013 Terpolilli et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: Resection of skull base lesions with orbital or optical nerve involvement poses a challenge due to their anatomical structure and to their close proximity to eloquent areas but nevertheless require radical resection in order to avoid recurrence. The current study reports our experience with the use of intraoperative computed tomography (iCT) scanning combined with a frameless neuronavigational system (NNS) with regard to feasibility and possible benefits of the method.

Method: Patients with tumorous lesions in relationship to orbit, sphenoid wing or cavernous sinus that were operated 02/09-10/12 using NNS and who received at least one iCT scan were included. In the operation theatre, a sliding gantry CT scanner connected to a NNS was used to obtain a CT scan for neuronavigation. Tumor resection was performed using NNS. After completion of resection a second iCT scan was performed under sterile conditions in selected cases. Surgical strategy was adapted accordingly, if necessary resection was continued. Postoperative follow-up was documented.

Results: 27 patients (meningioma WHO I: n=21, others: n=6) were included into the study. The most common clinical symptoms upon presentation were loss of visual acuity (44%) and exophthalmia (41%). 12 patients (44%) were admitted with recurrent tumor growth. Baseline CT scanning could be performed in all patients within 15 minutes. Neuronavigation using either iCT data combined with preoperative MRI scans (78%) or iCT data alone (22%) was used successfully in all patients, intraoperative control of resection by iCT was obtained in 14 cases (52%). Intraoperative imaging changed the surgical approach in 43% of these patients, either because iCT demonstrated residual tumor masses or because the second scan revealed additional tumor tissue not detected in the first scan due to overlay by osseous tumor parts; in these cases resection was continued. In the remaining cases resection was concluded as planned since iCT verified the microscopical finding of tumor resection status. In 7 cases, position and placement of orbital reconstruction material was assessed.

Conclusions: iCT can be easily implemented into the work flow during resection of orbital tumors. Intraoperative control of resection can help to improve extent of tumor removal, especially osseous tumor parts and masses within the orbit. iCT guided surgery therefore may be a promising tool to improve resection radicalness in skull base lesions with orbit or optical nerve involvement.