Use of Neuronavigation in posterior fossa and pineal region tumour surgery: Technical challenges

Abstract

Aim: To evaluate use of Neuronavigation in posterior fossa & pineal region tumour surgery. Material and Method: The present prospective non-randomised observational study was conducted at Neurosurgery Department, Bangur Institute of Neurosciences (B.I.N) / IPGMER & PG Hospital, Kolkata from Dec 2018 - Dec 2020. 50 cases were diagnosed with posterior fossa & pineal region tumour during the study period. Cranial image guided score (IGS) was calculated by the summation of grading during designing the flap/burr hole, delineation of the intraoperative anatomy, navigation and access to the lesion and resection of the lesion or completion of the procedure. The scoring ranged from 0-12 and the utility of IGS in cranial neurosurgical procedures was calculated based on the total points for each surgery. At the time of discharge/1 month/3 months/6 months/12 month’s outcome was assessed according to Glasgow outcome scale. One month after surgery, according to Karnofsky, the patient’s condition was divided into good and poor. Results: Biopsy, subtotal resection and gross total resection was achieved in 11 (22%), 15 (30%) and 24 (48%) subjects respectively. According to cranial IGS score, neuronavigation was more useful than conventional methods and irreplaceable among 52% and 26% of the subjects respectively. Only in two cases, it was not helpful. Conclusion: This study proved that the employed neuronavigation system is versatile and safe and that there are no adverse effects, complications or surgical mortality due to the device.