Artikel
“Intraoperative Structure Update®” in skull base tumor surgery
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Autoren
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Niklas Thon
- Neurochirurgische Klinik, Klinikum der Ludwig-Maximilians-Universität – Campus Großhadern, München, Deutschland
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Uli Mezger
- Brainlab AG, Feldkirchen, Deutschland
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Walter Rachinger
- Neurochirurgische Klinik, Klinikum der Ludwig-Maximilians-Universität – Campus Großhadern, München, Deutschland
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Jörg-Christian Tonn
- Neurochirurgische Klinik, Klinikum der Ludwig-Maximilians-Universität – Campus Großhadern, München, Deutschland
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: Intraoperative knowledge about extent of resection (EOR) and correlation with eloquent neuronal structures are important for maximal safe resection in skull base tumor surgery, especially when complete removal is not feasible and a combination with subsequent radiosurgery/radiotherapy is planned. Currently, ultrasound, computed tomography (iCT) or magnetic resonance imaging (iMRI) are modalities to assess EOR during surgery. However, their use is limited by difficult data interpretation, limited availability and high costs. Purpose of this study was to visualize EOR intraoperatively on the basis of segmented preoperative scans.
Method: In a prospective study design a navigated tool was used to "scan" the resection cavity intraoperatively and to update the preoperative, MRI-defined tumor object (intraoperative structure update®, ISU®; Brainlab®). The simulated residual tumor mass was visualized and quantified during neuronavigated skull base surgery and correlated with iCT/postoperative MRI as primary end point. Secondary end point was the surgeons' impression of the usefulness of ISU® for intraoperative decision making.
Results: In this pilot study on 8 adult patients undergoing resection of complex located, symptomatic skull base meningiomas, preoperative segmentation of overall tumor volume, anticipated residual tumor volume, and risk structures was always available for intraoperative neuronavigation. ISU® was easily performed and integrated smoothly into the surgical work-flow. Knowledge about residual tumor was particularly helpful in case of large, osseo-infiltrative sphenoid meningiomas and in case of broad infiltration of the cavernosous sinus. Correlation with postoperative MRI (8/8 patients) and iCT (2/8) showed good accuracy of simulated residual tumor tissues. The influence of brain shift, however, must be considered when the resection cavity is scanned.
Conclusions: ISU® is easy to use and offers accurate simulation of EOR during skull base tumor surgery. Calibration of surgical instruments (e.g. Cavitron Ultrasonic Aspirator, CUSA) might increase safety of resection. These data can also be integrated in treatment plans combining surgery and radiosurgery.
