Neuronavigation using an image-guided endoscopic transnasal-sphenoethmoidal approach to clival chordomas
Department of Neurosurgery, The Alfred Hospital, Monash University, Victoria, Australia. Neurosurgery
(Impact Factor: 3.62).
12/2007; 61(5 Suppl 2):212-7; discussion 217-8. DOI: 10.1227/01.neu.0000303219.55393.fe
Surgical approaches described for resection of clival tumors have been complicated, extensive, traumatic, and invasive. They are also associated with significant mortality and morbidity rates. We describe a minimally invasive, endoscopic transsphenoidal surgical treatment for clival tumors.
Three men, aged 43, 46, and 66 years, each presented with a history of headaches, diplopia, and multiple cranial nerve deficits. All preoperative magnetic resonance imaging scans showed large clival tumors. A neuronavigational image-guided endoscopic transnasal-sphenoethmoidal approach was performed to resect the clival tumors.
All three patients had near-total removal of clival tumors using this method, and the histology revealed chordomas. They underwent postoperative adjuvant radiotherapy. No complications were encountered. All patients were able to resume their usual activities on the same day after surgery. Furthermore, this technique greatly reduced patient discomfort, hastened recovery, and shortened the hospital stay.
The neuronavigation image-guided transsphenoidal approach is a viable, minimally invasive alternative for surgical treatment of clival tumors.
Available from: umassd.edu
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ABSTRACT: The effectiveness of sufficient statistics as features in the
detection/classification process is studied. The concept of a sufficient
statistic is reviewed and an empirical method of developing an
`apparent' sufficient statistic from training data is offered. Examples
of the performance enhancement achieved when using such statistics on
real world data in both linear and neural network classifiers are given
Acoustics, Speech, and Signal Processing, 1996. ICASSP-96. Conference Proceedings., 1996 IEEE International Conference on; 06/1996
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ABSTRACT: Transnasal endoscopic operative methods became increasingly popular in paranasal sinuses and cranial base surgery. Various types of localization systems are recently used to navigate through and between tangled anatomical structures in this region. The aim of this study was to compare (as basing on our own clinical experience), the advantages and limitations of the optical and electromagnetic neuronavigation systems.
Optical neuronavigation system (Stealth Station Treon plus, Medtronic, U.S.A.) and electromagnetic neuronavigation systems (DigiPointeur, Collin, France and Fusion ENT, Medtronic, USA) were used during endoscopic operations of paranasal sinuses, anterior skull base, orbits, parasellar region and clivus. The subject of comparison were precision of both system types and additional time necessary for setting up the system. Also assessed were convenience of navigation and easiness of manipulation with neuronavigated instruments during surgical procedures performed using classical endoscopic technique, bimanual technique and four hand technique.
The accuracy was high and comparable for both system types and did not deteriorate during the procedure. The time needed to set up of the optical system was somewhat longer. Surgeon's comfort during operative procedures was assessed as slightly higher for the electromagnetic systems, especially if four hand or bimanual techniques were used and if constant neuronavigation was indispensible. The optical system allows for navigation of a variety of surgical tools and this was considered a great advantage over the electromagnetic systems in this particular application.
The additional time spent in the operative theatre for getting a system ready is well paid off by better orientation of a surgeon in the operative field consequently increasing safety and higher accuracy of surgical procedure. What system should a surgeon use depends to a great extent on the type of planed procedure and preferred surgical technique.
Otolaryngologia polska. The Polish otolaryngology 01/2009; 63(3):256-60.
Available from: Justin F Fraser
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ABSTRACT: Transcranial approaches to clival chordomas provide a circuitous route to the site of origin of the tumor often involving extensive bone drilling and brain retraction, which places critical neurovascular structures between the surgeon and pathology. For certain chordomas, the endonasal endoscopic transclival approach is a novel minimal access, but it is an equally aggressive alternative providing the most direct route to the tumor epicenter.
The authors present a consecutive series of patients undergoing endonasal endoscopic resection of clival chordomas. Extent of resection was determined by postoperative volumetric MR imaging and divided into > 95% and < 95%.
Seven patients underwent 10 operations. Preoperative cranial neuropathies were present in 4. The mean patient age was 52.0 years. The mean tumor volume was 34.9 cm3. Intraoperative lumbar drainage was used in 1 patient, and the tumors extended intradurally in 3. One patient underwent 2 intentionally palliative procedures for subtotal debulking. Greater than 95% resection was achieved in 7 of 8 operations in which radical resection was the goal (87%). All tumors with volumes < 50 cm3 had > 95% resection (p = 0.05). The overall mean follow-up was 18.0 months. Cranial neuropathies resolved in all 3 patients with cranial nerve VI palsies. One patient with recurrent nasopharyngeal chordoma died of disease progression; another experienced 2 recurrences before receiving radiation therapy. All surviving patients remain progression free. There were no intraoperative complications; however, 1 patient developed a pulmonary embolus postoperatively. There were no postoperative CSF leaks.
The endonasal endoscopic transclival approach represents a less invasive and more direct approach than a transcranial approach to treat certain moderate-sized midline skull base chordomas. Longer follow-up is necessary to determine comparability to transcranial approaches for long-term control. Large tumors with significant extension lateral to the carotid artery may not be suitable for this approach.
Journal of Neurosurgery 08/2009; 112(5):1061-9. DOI:10.3171/2009.7.JNS081504 · 3.74 Impact Factor
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