Application Of Neuronavigation Research Articles

Application of Neuronavigation in Microvascular Decompression: Optimizing Craniotomy and 3D Reconstruction of Neurovascular Compression.

Microvascular decompression (MVD) is the best curative treatment for trigeminal neuralgia and hemifacial spasm. We used the neuronavigation to reconstruct the 3D image of cranial nerve and blood vessel to identify the neurovascular compression, and to reconstruct the venous sinus and skull to optimize craniotomy. A total of 11 trigeminal neuralgia and 12 hemifacial spasm cases were selected. All patients had preoperative MRI which included 3D Time of Flight (3D-TOF), Magnetic Resonance Venography (MRV) and computer tomography (CT) for navigation. Imaging sequences were fused and reconstructed by navigation system before operation. The 3D-TOF images were used to delineate cranial nerve and vessel. The CT and MRV images were used to mark transverse sinus and the sigmoid sinus for craniotomy. All patients underwent MVD and have the preoperative view compared with intraoperative findings. Approaching to the cerebellopontine angle right after opening the dura and got no cerebellar retracion or petrosal vein rupture during craniotomy. Ten of 11 trigeminal neuralgia and all 12 hemifacial spasm patients got excellent preoperative 3D reconstruction fusion images, which were also confirmed by intraoperative findings. All 11 trigeminal neuralgia patients and 10 of 12 hemifacial spasm patients were symptom free without any neurological complications just after the surgery. Other 2 hemifacial spasm patients got delayed resolution in 2 months after surgery. Through the neuronavigation guided craniotomy and the 3D neurovascular reconstruction, surgeons can better identify the compression of nerve and blood vessel, and reduce complications.

Neuronavigation in falcine meningiomasare surgery: Initial results from a Vietnamese multi-center study.

Neuronavigation has been applied in neurocenters to help neurosurgeons plan the way to resect tumor totally and decline the neuro-injuries. This study aims to initially evaluate the result of microsurgery applying neuronavigation in treating falcine meningioma, which has not been reported comprehensively in Vietnam. This cross-sectional study enrolled 62 patients diagnosised with falcine meningioma and treated by applying neuronavigation in operation in Neurosurgery Department of Military Hospital 103 and Viet Duc University Hospital from July 2015 to March 2017. Patients were assessed complications as well as residual lesions. Evaluate surgical results when discharging from hospital according to Ojemann MD standard. Mean tumor volume was 67.37±66.61cm³ (range 6-370cm³). Unilateral access site was the most common with 85.48%. Mean surgery duration was 209.84±70.86min. There were 27 out of 62 patients (43.55%) need blood transfusion in surgery. Tumor volume had an impact on blood transfusion in operation with p=0.002. 82.26% of patients had total resection (Simpson I,II). There were 4.84% of patients having haemorrhage and 3 patients (4.84%) had wound infection after operation. Short-term outcome was evaluated according to Ojemann MD standard: good outcome was 67.74%, medium 17.74%, and poor outcome 14.52%. The application of neuronavigation and microsurgery enables surgeons to access falcine meningiomasare exactly, lessen the surgery duration, limit blood transfusion and complications after operation.

Application of neuronavigation combined with yellow fluorescence staining in the resection of supratentorial glioma

Objective To explore the application of neuronavigation combined with yellow fluorescence staining in the operation of glioma. Methods A retrospective study was conducted on the clinical data of 172 patients with supratentorial glioma who underwent surgical treatment at Department of Neurosurgery, Zhongnan Hospital of Wuhan University from January 2016 to March 2018. Among them, 55 cases were treated with neuronavigation combined with yellow fluorescence staining (navigation + fluorescence group) and 117 cases with conventional surgical techniques (control group). There were 81 patients with tumors involving the eloquent area, and neuroelectrophysiological monitoring and/or intraoperative awake anesthesia were applied in all those patients. Total resection rate was compared between the 2 groups to analyze the factors influencing the total resection rate. Results Total resection was performed in 58 patients confirmed by postoperative imaging. The total resection rate was 45.5%(25/55) in group of neuronavigation + fluorescence and 28.2%(33/117) in the control group. There was statistically significant difference between the 2 groups(P=0.026). Multiple logistic regression analysis revealed that involvement of eloquent area (OR=0.502, 95% CI: 0.253-0.998, P=0.049) and the technique of neuronavigation plus fluorescence (OR=2.173, 95% CI: 1.080-4.371, P=0.030) were independent prognostic factors of the total resection for glioma. Among the 81 patients involving the eloquent area, total resection was achieved in 21 patients(25.9%), of whom 13(61.9%) were treated with fluorescence combined with neuronavigation. Incomplete resection was achieved in 60 patients, of whom 16(26.7%) were treated with fluorescence combined with neuronavigation. There was statistically significant difference between the 2 groups (P=0.004). Multiple logistic regression analysis revealed that the technique of neuronavigation combined with fluorescence (OR=3.896, 95% CI: 1.331-11.405, P=0.013) were independent prognostic factors of total resection. Conclusion Neuronavigation combined with yellow fluorescence staining can be helpful in the total resection of glioma . Key words: Glioma; Neuronavigation; Fluorescence staining; Neurosurgical procedures; Extent of resection

Evaluation of Neuronavigation in Glioma Surgery

Background: Glioma is one of the most common intracranial tumors, the treatment for which is surgical resection. Cerebral gliomas in eloquent brain areas are closely associated with important structures. The deep location of such gliomas renders complete resection difficult overlaying structures can be injured, causing hemiplegia, aphasia, coma, and other severe complications. The degree of resection directly influences the prognosis of patients. The application of neuronavigation enables the accurate localization of lesions during surgery, significantly improving microneurosurgery. The accuracy of navigation, however, has typically been compromised by several factors, including operation error, shifting of registration system, and intraoperative brain tissue deformation (brain shift). Aim of Study: The aim of the study is to evaluate and demonstrate the efficacy of neuronavigation in the management of brain gliomas. Patients and Methods: This is a prospective randomized clinical trial study included 35 patients with brain glioma were operated for excision or biopsy taken. Results: Localization of burr hole and craniotomy flap was excellent in 33 patients (94.2%) and fault in 2 cases (5.7%), 29 patients (82.8%) had near total excision of the lesions, and 6 patients (17.1%) had burr hole biopsy, intra operative course was smooth in 33 patients (94.2%) with no intra operative complications, 2 cases (5.7%) developed intra operative bleeding that was due to liver problems. Reading the post operative imaging shows that 27 patients (77.1%) had mild to moderate post operative edema around the site of the lesion, the other eight cases were free of hemorrhage, infarction or edema. Conclusion: We found that neuronavigation is very helpful in our cases in localization of the lesions, decreasing time of surgery, reducing morbidity and mortality and decreasing hospital stay. There are concerns about navigation systems including time consuming, calculation and registration, restriction of space and view inside the operating field, and so on, we didn’t find these issues as obstacles in our work, but we found that there are many advantages that can be helpful in the process of operation.

Application of neuronavigation combined with intraoperative related assistive technology in craniotomy

Objective To explore the role of neuronavigation combined with intraoperative ultrasound Doppler and neurophysiological monitoring in intracranial lesion surgery. Methods A total of 34 patients with intracranial lesions who underwent surgical treatment at Neurosurgery Department of the First Affiliated Hospital of Inner Mongolia Medical University from January 2012 to July 2015 were retrospectively reviewed. All operations were guided by neuronavigation combined with intraoperative ultrasonic Doppler localization. Intraoperative resuscitation and intraoperative electrophysiological monitoring were performed in 10 cases with lesions located at functional areas. Results In 34 cases, brain shift occurred in 24 cases after intraoperative navigation and the distance was 4-13 (6.7±2.4) mm. For ultrasonic assisted navigation, the lesion localizing accuracy rate was 100%. Intraoperative ultrasonography showed that total resection was achieved in 27 cases, subtotal resection in 5 and partial resection in 2. There were 2 cases of transient unilateral motion dysfunction, 1 case of transient language disorder, 1 case of intracranial infection, 1 case of epileptic seizure and no deaths. Postoperative images showed that the brain damage was mild, the cortex was intact and the extent of lesion resection was consistent with intraoperative ultrasound demonstration. None of the 10 patients with functional area lesions showed postoperative functional impairment. Conclusion Neuronavigation combined with intraoperative assistive technology could help precisely localize lesions, protect brain cortex, maximize the removal of lesions and reduce the complications related to the operations. Key words: Brain diseases; Neurosurgical procedures; Neuronavigation; Ultrasonography; Nervous system physiological processes; Intraoperative waken-up

Clinical Long-Term Follow-Up Evaluation of Functional Neuronavigation in Adult Cerebral Gliomas

To assess the application of functional neuronavigation in surgeries of adult cerebral gliomas. We performed a retrospective analysis of 375 cases of adult cerebral glioma patients who underwent microsurgical treatment between 2011 and 2017 in our department. Among them, 142 patients underwent surgery using functional neuronavigation (group A), and the other 233 patients were operated on without the help of functional neuronavigation (group B). For both groups, we categorized them into several subgroups according to the lesion locations. A significant difference in the gross total resection rate was observed between group A and group B (P = 0.001 for overall; P = 0.036 for EO area; and P = 0.004 for BBT area). The postoperative complication rate of group A was much lower than that of group B (P = 0.003 for overall; and P = 0.016 for BBT area). The postoperative 6-month Karnofsky Performance Scale score of all patients in group A was significantly higher than that of group B. Kaplan-Meier survival analyses showed significant increases in the median survival time of group A compared with that of group B (P < 0.001 for overall; P = 0.012 for EO area; P = 0.006 for BBT area), and the Cox proportional regression analysis estimated the hazard ratio of the functional neuronavigation to be 0.533, helping reduce the risk of death by 46.7%. This study confirmed that the application of neuronavigation in adult glioma surgery can improve postoperative quality of life and lengthen the survival time of patients, especially in cases involving the brainstem and the eloquent area.

Neuronavigation combined with nerve electrophysiology in excision of brain abscess: A case report and literature review

A brain abscess is a parenchymal infection, which is a severe intracranial infectious disease. Although the incidence is low, it causes serious inflammation and neurological deficits. The current treatments for brain abscesses are primarily surgical, including abscess resection or puncture and drainage. In recent years, extensive application of neuronavigation and electrophysiological monitoring technology have improved the safety and reliability of neurosurgery. To explore the application and curative effect of neuronavigation combined with neurophysiological techniques in the treatment of brain abscesses, we retrospectively analyzed a female patient who had undergone neurological monitoring and neuronavigation-assisted surgery to remove an abscess in 2015. Diagnosis and treatment are reported.

Application of neuronavigation multimodal fusing combining intraoperative electrophysiological techniques in the tumor surgery of brain motor areas

Objective To investigate the clinical application value of neuronavigation multimodal fusing (DTI and BOLD) combining intraoperative electrophysiological monitoring techniques in tumor surgery of brain motor areas. Methods From October 2014 to January 2015, 20 right-handed patients whose lesions were located near the brain motor areas admitted to the Department of Neurosurgery, Changhai Hospital, the Second Military Medical University were analyzed retrospectively. The patients received preoperative magnetic resonance diffusion tensor imaging (DTI) and blood oxygen level dependent-functional magnetic resonance imaging (BOLD-fMRI) examinations. The original data of white matter fiber tracts and BOLD data were obtained. The neural navigation multimodal fusion DTI, BOLD, anatomical images [brain magnetic resonance venography (MRV), if necessary], and the three-dimensional reconstruction were performed. The microsurgery was performed under the assisted navigation during the operation, and the anterior central gyrus, central sulcus, posterior central gyrus, and subcortical tracts were determined under the neural electrophysiological monitoring. Results Of the 20 patients with motor area tumor, the lesions of 17 patients were resected, and 3 were resected subtotally. The intraoperative electrophysiological results were consistent with the preoperative DTI and BOLD reconstructed results. Postoperative pathological results: 9 patients had glioma (low-level 4 and high-level 5) and 11 had meningioma. The postoperative muscle strength of 15 patients did not have any change, 5 had transient hemiparesis. DTI showed that there was no obvious damage to the nerve tracts at 24 h after procedure. After being followed up for 2 weeks to 3 months, the patients were able to take care of themselves. Conclusions Neuronavigation multimodal fusing can accurately locate the motor function areas, and combined electrophysiological monitoring can compensate for the errors caused by the drift of the neural navigation. The peripheral adjacent tracks and functional areas were protected real timely during the operation in order to reduce the postoperative neurological dysfunction. The tumors were resected in a maximum degree within the safe range. In addition, the intraoperative electrophysiological monitoring and early postoperative DTI examination can predict the postoperative muscle strength and improve the postoperative quality of life of patients. Key words: Neuronavigation; Diffusion tensor imaging; Functional magnetic resonance imaging; Electrophysiology; Microsurgery

Neuronavigational Approach for Orbital Neurofibroma Excision: A Case Report

Orbital neurofibromas are uncommon in adults, accounting for approximately 1%-3% of all space occupying lesions of the orbit. The complex anatomy of the orbital region, with the pronounced vulnerability of its neurovascular structures, requires particular surgical precautions. Neuronavigation, as a high-tech device for intraoperative safety, represents a valuable option for the confined orbital space. However, the application of neuronavigation in orbital surgery has been rarely reported. The authors present a case report of a 32-year-old female with an isolated localized neurofibroma surgically approached by intraoperative navigation and a review of the literature.

Neuro-navigation: An Adjunct in Craniofacial Surgeries: Our Experience

Due to the destruction of osseous landmarks of the skull base or paranasal sinuses, the anatomical orientation during surgery of frontobasal or clival tumors with (para) nasal extension is often challenging. In this relation, Neuro-navigation guidance might be a useful tool. Here, we explored the use of Neuro-navigation in an interdisciplinary setting. The surgical series consists of 3 patients who underwent Lefort-I access osteotomy and surgical decompression of the tumor. The procedures were planned and assisted by neuro-navigation techniques with image fusion of CT and MRI. Two of the patients were diagnosed to have clival chordoma and one had extensive JNA. The application of Neuro-navigation in the combined approaches was both safe and reliable for delineation of tumors and identification of vital structures hidden or encased by the tumors. There was no perioperative mortality. Tumors were either removed completely, or subtotal resection was achieved. Craniofacial approaches with intra-operative neuro-navigational guidance in a multidisciplinary setting allow safe resection of large tumors of the upper clivus and the paranasal sinuses involving the anterior skull base. Complex skull base surgery with the involvement of bony structures appears to be an ideal field for advanced navigation techniques given the lack of intraoperative shift of relevant structures.

Selective radiofrequency thermocoagulation for trigeminal neuralgia

To study the technique and experience of selective radiofrequency thermocoagulation (SRFTC) for trigeminal neuralgia (TN) and the application of neuronavigation in SRFTC for TN. SRFTC was performed in 3269 TN patients and neuronavigation-assisted SRFTC in 36 of them. Follow-up was carried out for over 2 years in 1722 cases. An excellent efficacy was achieved in 2590 cases, a fair outcome in 548 cases and no response in 131 cases. The recurrence rates at one and two years were 10.5% and 25.0% respectively. The efficacy was excellent in all cases treated by neuronavigation-assisted SRFTC. The effective rate was 96%. Neither serious complication nor death occurred in this series. SRFTC for TN is both safe and effective. And the neuronavigation technique can not only increase the surgical efficacy of SRFTCP for TN but also decrease the surgical risks.

Transsphenoidal surgery in a patient with acromegaly and McCune–Albright syndrome: application of neuronavigation

The McCune-Albright syndrome (MAS) is characterized by a clinical triad of polyostotic fibrous dysplasia, café-au-lait hyperpigmented macules, and hypersecretory endocrinopathies. Acromegaly is an uncommon manifestation of the endocrine disturbance associated with MAS, and the role of surgery in managing these cases has been a topic of debate. The authors present the case of a 35-year-old man with MAS who was also diagnosed with acromegaly, hyperprolactinemia, and pituitary macroadenoma. The patient had an 18-year history of fibrous dysplasia involving the right frontal bone and ribs as well as multiple endocrinopathies, but no cutaneous hyperpigmented macules. An oral glucose tolerance test demonstrated partial suppression of plasma levels of growth hormone (GH). The patient underwent transsphenoidal resection of the pituitary tumor, performed with assistance of neuronavigation, and tolerated the procedure well. After the surgery, both prolactin and GH levels returned to normal. These results suggest that neuronavigation-assisted transsphenoidal surgery can safely remove pituitary adenomas associated with MAS and successfully treat the underlying endocrine abnormalities.

Application of neuronavigation in resection of intracranial deep tumor

目的 评价神经导航系统在脑深部肿瘤显微手术中的应用价值.方法应用StealthNavigation神经导航系统对46例脑深部肿瘤手术治疗,术前采用神经影像MRI导航扫描,对病灶进行三维重建,制定显微手术治疗计划,术中实时导航指导手术切除范围,分析治疗效果.结果肿瘤及其周围结构定位准确,手术全切除39例(84.7%),次全切除3例(6.6%),大部分切除4例(8.7%);术后症状改善或不变41例(89.1%),症状加重或出现新症状5例(10.9%),无死亡病例.结论应用神经导航系统可以精确定位脑深部肿瘤,设计最佳手术入路,有助于提高显微手术疗效,防止手术副损伤,降低手术并发症。

Frameless image-guided neuronavigation in orbital surgery: practical applications

Frameless neuronavigation has been increasingly used in intracranial and spinal neurosurgery. However, the application of neuronavigation in orbital surgery has not yet been reported. The purpose of this study was to evaluate whether frameless navigation in the orbit provides sufficient clinical application accuracy and thus a useful tool in orbital surgery. A frameless infrared-based neuronavigation system (VectorVision, BrainLAB, Heimstetten, Germany) was used in the microsurgical removal of 11 orbital tumors (five cavernomas, three lymphomas, two dermoid tumors, and one rhabdomyosarcoma). The transconjunctival approach was performed in seven cases, lateral orbitotomy in three cases, and the extradural pterional approach was performed in one case. The surgery was successful and without any complications in all cases. The registration accuracy of the neuronavigation was between 1.8 and 2.2 mm, with a mean of 1.9 mm. Subtotal tumor debulking was performed in one case with lymphoma. One patient was only biopsied due to suspected systemic lymphoma disease. Total removal of the tumor could be accomplished in the other nine patients. Image guidance during orbital surgery offered excellent three-dimensional guidance on the surface of the intraorbital lesions, allowing a safer, more controlled surgery. The surgical targets in the orbit are fixed structures, thus no shifting occurs and continuous high intraoperative navigation accuracy can be achieved. The use of the navigation clearly reduces the operative risk and increases the effectiveness of microsurgical orbital procedures.

Neuronavigation. Computer-assisted neurosurgery

The use of stereotactic methods for the resection of subcortical lesions is heavily advocated in clinical neurosurgery introducing the term "neuronavigation". Though being an unequivocally elegant technique for the localisation and delineation of pathological lesions in the central nervous system neuronavigation has not been validated by any prospective randomized controlled trial. The method is prone to significant errors as to the intraoperative localisation based upon preoperative three-dimensional images. The maximum error can be up to 2.6 cm depending on the extent of the so-called brain shift. In comparison classical frame based stereotaxy has a mean error of +/- 1 mm and remains the gold standard for the exact three-dimensional localisation of a given lesion. The value of neuronavigation is evident for small deep seated vascular lesions. For metastatic tumors or skull base tumors the usefulness is rather marginal because alternative therapies are available with proven and equivalent efficacy and reduced morbidity on one hand, and because of the anatomy of the tumor which makes neuronavigation unnecessary. For the currently most common application of neuronavigation, i.e. surgery of gliomas, no significant improvements of therapeutic results can be expected from neuronavigation. The biology of gliomas limits any mechanical approaches.