gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Frameless navigated endoscopic port surgery for the resection of deep-seated small intra-parenchymal cavernomas

Meeting Abstract

  • Xiaolei Chen - Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Fangye Li - Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Gang Zheng - Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Jingjiang Li - Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Sheng Hu - Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Ting Zhang - Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
  • Bai-nan Xu - Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China

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. DocMO.19.06

doi: 10.3205/13dgnc166, urn:nbn:de:0183-13dgnc1667

Published: May 21, 2013

© 2013 Chen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Deep-seated small intra-parenchymal cavernomas are difficult to be localized intraoperatively with conventional frameless navigation due to the "brain shift" effect. we conducted this study to compare the results of cavernomas resection with frameless navigated endoscopic port surgery (EPS) versus conventional frameless navigation, and to assess the clinical usefulness of navigated EPS.

Method: Between 2009 and 2012, 28 patients with deep-seated (distance longer than 2 cm from cortex), small (diameter less than 2 cm), intra-parenchymal cavernomas were enrolled into this study. Conventional frameless navigation guided surgery was performed in 15 (53.6%) patients, while in 13 (46.4%) patients, frameless navigated EPS was performed. A 1.5T Intra-operative MRI (iMRI) was used in all cases for the compensation of "brain shift" and to update the navigation system. The frequency of iMRI scans and the total time of procedure for all the cases were analyzed. The flexibility of procedures and postoperative clinical morbidity was also evaluated in each patient.

Results: Regarding the average iMRI scan times, the frameless navigated EPS was superior than the conventional navigation (mean scan times: 1.23 times versus 1.67 times, p<0.05). There was also significant difference between two groups concerning the average total time of procedure (navigated EPS : conventional navigation; 170 minutes versus 280 minutes; p<0.05).

Conclusions: Navigated EPS is helpful for fast localization of deep-seated small intra-parenchymal cavernomas. Image guided EPS provides high accuracy and efficiency for lesion targeting and permits excellent anatomic orientation. Accordingly, small and tailored safe exposure can be obtained with navigated EPS and multimodal neuronavigation.