Keyhole Neurosurgery Research Articles

TUMORS OF THE LATERAL AND THIRD VENTRICLE

Intraventricular tumors usually are managed by approaches and microsurgical techniques that need retraction and dissection of important brain structures. Minimally invasive endoscopic procedures achieve a remarkable alternative to conventional microneurosurgical techniques. Endoscope-assisted microneurosurgery may be a minimally invasive technique with maximally effective treatment. Using the keyhole concept for planning the surgical strategy, the reduction of the brain retraction is achieved, which is one of the main benefits of this technique. We treated 35 patients (16 female patients and 19 male patients) with tumors in the lateral (n = 8) and the third (n = 27) ventricle. Patient age at the date of surgery ranged from 5 to 73 years. The follow-up period ranged from 6 to 83 months. The tumors were operated on using transcortical, transcallosal, or suboccipital transtentorial or infratentorial supracerebellar approaches after precise planning of the skin incision, the trephination, and the trajectory to the center of the tumor, performed earlier with a magnetic resonance imaging scan. Total removal of the tumor was achieved in 28 patients (78.5%). In 2 patients (6.5%), recurrent tumor occurred. In 5 patients (15%), parts of the tumors remained because of infiltration of eloquent areas. Overall clinical improvement was achieved in 31 patients (87%). Three patients (10%) were unchanged and 1 patient (3%) deteriorated. Endoscope-assisted keyhole neurosurgery seems to be a safe method of removing tumors in all regions inside the ventricular system with a low risk of permanent neurological deficits. The exact surgical corridor planning on the basis of the keyhole strategy offers less traumatic exposure of even deep-seated endoventricular tumors.

Image-guided system with miniature robot for precise positioning and targeting in keyhole neurosurgery

This paper describes a novel image-guided system for precise automatic targeting in minimally invasive keyhole neurosurgery. The system consists of the MARS miniature robot fitted with a mechanical guide for needle, probe or catheter insertion. Intraoperatively, the robot is directly affixed to a head clamp or to the patient's skull. It automatically positions itself with respect to predefined targets in a preoperative CT/MRI image following an anatomical registration with an intraoperative 3D surface scan of the patient's facial features and registration jig. We present the system architecture, surgical protocol, custom hardware (targeting and registration jig), and software modules (preoperative planning, intraoperative execution, 3D surface scan processing, and three-way registration). We also describe a prototype implementation of the system and in vitro registration experiments. Our results indicate a system-wide target registration error of 1.7 mm (standard deviation = 0.7 mm), which is close to the required 1.0–1.5 mm clinical accuracy in many keyhole neurosurgical procedures.

Image-guided system with miniature robot for precise positioning and targeting in keyhole neurosurgery

This paper describes a novel image-guided system for precise automatic targeting in minimally invasive keyhole neurosurgery. The system consists of the MARS miniature robot fitted with a mechanical guide for needle, probe or catheter insertion. Intraoperatively, the robot is directly affixed to a head clamp or to the patient's skull. It automatically positions itself with respect to predefined targets in a preoperative CT/MRI image following an anatomical registration with an intraoperative 3D surface scan of the patient's facial features and registration jig. We present the system architecture, surgical protocol, custom hardware (targeting and registration jig), and software modules (preoperative planning, intraoperative execution, 3D surface scan processing, and three-way registration). We also describe a prototype implementation of the system and in vitro registration experiments. Our results indicate a system-wide target registration error of 1.7 mm (standard deviation = 0.7 mm), which is close to the required 1.0–1.5 mm clinical accuracy in many keyhole neurosurgical procedures.

Tumors of the Lateral and Third Ventricle: Removal under Endoscope-assisted Keyhole Conditions

Intraventricular tumors usually are managed by approaches and microsurgical techniques that need retraction and dissection of important brain structures. Minimally invasive endoscopic procedures achieve a remarkable alternative to conventional microneurosurgical techniques. Endoscope-assisted microneurosurgery may be a minimally invasive technique with maximally effective treatment. Using the keyhole concept for planning the surgical strategy, the reduction of the brain retraction is achieved, which is one of the main benefits of this technique. We treated 35 patients (16 female patients and 19 male patients) with tumors in the lateral (n = 8) and the third (n = 27) ventricle. Patient age at the date of surgery ranged from 5 to 73 years. The follow-up period ranged from 6 to 83 months. The tumors were operated on using transcortical, transcallosal, or suboccipital transtentorial or infratentorial supracerebellar approaches after precise planning of the skin incision, the trephination, and the trajectory to the center of the tumor, performed earlier with a magnetic resonance imaging scan. Total removal of the tumor was achieved in 28 patients (78.5%). In 2 patients (6.5%), recurrent tumor occurred. In 5 patients (15%), parts of the tumors remained because of infiltration of eloquent areas. Overall clinical improvement was achieved in 31 patients (87%). Three patients (10%) were unchanged and 1 patient (3%) deteriorated. Endoscope-assisted keyhole neurosurgery seems to be a safe method of removing tumors in all regions inside the ventricular system with a low risk of permanent neurological deficits. The exact surgical corridor planning on the basis of the keyhole strategy offers less traumatic exposure of even deep-seated endoventricular tumors.

Miniature robot-based precise targeting system for keyhole neurosurgery: Concept and preliminary results

This paper describes a novel system for precise automatic targeting in minimally invasive neurosurgery. The system consists of a miniature robot fitted with a rigid mechanical guide for needle, catheter, or probe insertion. Intraoperatively, the robot is directly affixed to the patient skull or to a head clamp. It automatically positions itself with respect to predefined targets in a preoperative CT/MRI image following a three-way anatomical registration with an intraoperative 3D-laser scan of the patient face features. We describe the system architecture, surgical protocol, software modules, and implementation. Registration results on 19 pairs of real MRI and 3D laser scan data show an RMS error of 1.0 mm (std = 0.95 mm) in 2 s.

Endoscopic and Minimally Invasive Microsurgical Approaches for Treating Brain Tumor Patients

Recent developments in neuroendoscopy and minimally invasive procedures have greatly impacted the diagnosis and treatment of brain tumors. In this paper, we will review these innovations and discuss how they have influenced our approach to the treatment of intraventricular and pituitary tumors. Finally, the concept of keyhole neurosurgery is illustrated by discussing 'eyebrow orbitotomy' approach as an example. As noninvasive therapeutic alternative become available, future neurosurgeons will be challenged to develop effective and less invasive surgical approaches for the diagnosis and treatment of patients will brain tumors.