The use of intraoperative neuroimaging tools and a navigation system in surgical treatment of primary and metastatic tumors of the spine

Abstract

Surgical treatment of spinal tumors is associated with a high risk of intraoperative complications, including injury to the spinal cord, its roots, and large vessels both during tumor resection and at the stabilization stage during implantation of pedicular or corporal screws. The use of intraoperative neuroimaging tools and a navigation system in surgical treatment of oncological diseases of the spine enables identifying the location and extension of a tumor lesion directly in the operating room, which provides control of the resection area and the possibility of the spine stabilization under disturbed anatomy conditions when bone density is altered by the osteolytic process or systemic changes. Also, the risk of injury to the major blood vessels is reduced. Surgical treatment of 156 patients with primary and metastatic tumors of the spine was performed at the Burdenko Neurosurgical Institute in the period from 2002 to December 2014. Twelve patients underwent diagnostic intervention (transcutaneous biopsy), and 35 patients underwent surgery using intraoperative CT and a navigation systems. The indication for biopsy using both CT and the navigation system was the presence of a spinal tumor not verified by a pathomorphological examination. An O-arm intraoperative computed tomography scanner and a Medtronic's StealthStation S7 Navigation System were used in all cases. The use of both CT and the navigation system provides high quality treatment and significantly reduces radiation exposure to the medical personnel and patient. The possibility of intraoperative identification of the location and extension of a tumor in bone tissue facilitates adequate tumor resection within the intact surgical margin, with the surrounding vessels and neurological structures being under real-time control.