gms | German Medical Science

66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Friendship Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

7. - 10. Juni 2015, Karlsruhe

The usefulness of neuronavigation and intraoperative MRI control in the transsylvian, transinsular approach for insular cavernomas

Meeting Abstract

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  • Paulo de Carvalho - International Neuroscience Institute, Hannover
  • Ramin Mahmoodi - International Neuroscience Institute, Hannover
  • Helmut Bertalanffy - International Neuroscience Institute, Hannover

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.26.05

doi: 10.3205/15dgnc247, urn:nbn:de:0183-15dgnc2478

Veröffentlicht: 2. Juni 2015

© 2015 Carvalho et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Surgical management of cavernomas of the insular lobe is especially challenging due to the proximity to the basal ganglia, internal capsule and lenticulostriate arteries. Careful surgical planning, precise localization and anatomical orientation are crucial for resection of these deep seated vascular malformations. Neuronavigation in conjunction with the distal transsylvian transinsular approach provide direct and short trajectory to this lesions. During the past 4 years intraoperative MRI control (iop MRI) was used as additional tool. The purpose of the present study is to present and assess the clinical usefulness of image guidance and the value of iop MRI for operations on insular cavernomas.

Method: We present 18 patients harboring an insular cavernoma that were surgically accessed via an image-guided transsylvian, transinsular approach. We describe and assess the usefulness of neuronavigation for 1) accurate planning of the craniotomy, 2) identification of the distal sylvian fissure, 3) finding the exact site for insular corticotomy and 4) the value of iop MRI control in documenting complete removal of the cavernoma.

Results: The precise planning of the approach with determination of the ideal trajectory of dissection toward the cavernoma was possible in all patients, although multiple corticotomies were performed in one of them. The size of the vascular malformation ranged from 4 to 35 mm in the largest diameter. The depth of the tumors varied from 0 to 20mm from the insular surface. Complete resection was achieved in all patients and confirmed by iop MRI control in 3 patients. No surgical complications occurred, and the postoperative course was uneventful in all patients.

Conclusions: Image guidance during surgery for insular cavernomas provides high accuracy for lesion targeting and permits excellent anatomic orientation. Accordingly, safe exposure can be obtained because of a tailored dissection of the distal sylvian fissure and minimal insular corticotomy. Iop MRI is an excellent tool to confirm the total removal of the vascular malformation and to exclude hemorrhage or ischemia during surgery.