Frameless, pinless stereotactic neurosurgery in children
ABSTRACT Frameless neuronavigation has been established as a useful adjunct to intracranial surgery; however, the procedure is limited in young children by the need for rigid skull fixation with pins. Pin fixation is difficult and hazardous for patients younger than 2 years of age. Minor risks have been associated with pin fixation in older patients also, including scalp laceration, skull fracture, and epidural hematoma.
The authors adapted a pinless head fixation system, consisting of a beanbag device, for use with frameless neuronavigation. This system was used to perform intracranial neurosurgical procedures in nine patients.
This pinless, frameless method provides a new option for children who are unable to sustain rigid head fixation. It is also an alternative to rigid pin fixation for patients of any age.
- SourceAvailable from: Luciano Furlanetti
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- "Authors found out that 82% of procedures based on CT and 92% of those based on MRI had an error inferior to 2 mm. Reavey- Cantwell  also described a platform linked to the Mayfield holder, called " beanbag head-holder " , that enable neuronavigation without pinning. Moreover, large studies showed that frameless stereotactic surgery takes more time in the operating room and is more expensive than frame-based procedures, although the diagnosis and complication rates are equivalent . "
ABSTRACT: Stereotactic frame-based procedures proved to be precise, safe and are of widespread use among adult patients. Regarding pediatric patients few data is available, therefore the use of the stereotactic frame remains controversial in this population. This motivated us to report our experience in stereotactic procedures in the youngest patients and review the literature concerning this subject. All frame-based procedures performed in patients younger than seven years in the University of Freiburg during the last 10 years were retrospectively analyzed and discussed under the light of the current literature. The studied population was composed of 72 patients under the age of seven (mean 3.4 ±2.1 years-old), in whom 99 stereotactic procedures were performed. Brain tumor was present in 60 patients, hydrocephalus in five, cystic lesions in three, intracranial abscess in three and epilepsy in one patient. Stereotactic surgery was performed in 36 cases for brachytherapy, in 29 for biopsy, in 20 cases for cyst puncture, in eight for stereotactically guided endoscopic ventriculostomy, in five for catheter placement and in one case for depth electrode insertion. The overall complication rate was 5%. There were three cases of pin penetration through the skull, one case of frame dislocation after extensive cyst drainage and two skull fractures. Neurologic deficit related to frame fixation was observed in none of the cases. In disagreement with other authors, no case of pin related infection, air embolism, hematoma or CSF leak was observed. Frame-based stereotactic neurosurgery is a safe technique also in the youngest patients. Rather than the simple use of torque-limiting devices training and experience in the manual adjustment of the stereotactic frame in children have been proven to be crucial factors that contribute to reducing pin related complications.Clinical Neurology and Neurosurgery 12/2014; 130. DOI:10.1016/j.clineuro.2014.12.011 · 1.25 Impact Factor
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ABSTRACT: A head fixation device with pins is commonly used for immobilization of the patient's head during craniotomy. The safety of head fixation devices in children has been discussed rarely in the literature. The purpose of this report is to review our experience with complications of head fixation with pins in children undergoing craniotomies and to review the literature on this subject. The database of the Division of Neurosurgery was reviewed to identify children who had cranial complications related to the use of a pin head fixation device. The charts of these patients were reviewed retrospectively. Five of 766 children (0.65%) undergoing craniotomies with pin fixation of the head had depressed skull fractures and/or epidural hematomas from the pin fixation. Age ranged from 2.6 to 7.5 years; all fractures were temporal and occurred during posterior fossa craniotomies. Depressed skull fractures and associated epidural hematomas need to be considered as possible complications of pin fixation of the head for craniotomy in young children.Child s Nervous System 09/2008; 24(8):917-23; discussion 925. DOI:10.1007/s00381-008-0621-9 · 1.16 Impact Factor
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ABSTRACT: The authors investigated the practicality of electromagnetic neuronavigation in routine clinical use, and determined the applications for which it is at the advantage compared with other systems. A magnetic field is generated encompassing the surgical volume. Devices containing miniaturized coils can be located within the field. The authors report on their experience in 150 cases performed with this technology. Electromagnetic neuronavigation was performed in 44 endoscopies, 42 ventriculoperitoneal shunt insertions for slit ventricles, 21 routine shunt insertions, 6 complex shunt insertions, 14 external ventricular drain placements for traumatic brain injury, 5 awake craniotomies, 5 Ommaya reservoir placements, and for 13 other indications. Satisfactory positioning of ventricular catheters was achieved in all cases. No particular changes to the operating theater set-up were required, and no significant interference from ferromagnetic instruments was experienced. Neurophysiological monitoring was not affected, nor did it affect electromagnetic guidance. Neuronavigation enables safe, accurate surgery, and may ultimately reduce complications and improve outcome. Electromagnetic technology allows frameless, pinless, image-guided surgery, and can be used in all procedures for which neuronavigation is appropriate. This technology was found to be particularly advantageous compared with other technologies in cases in which freedom of head movement was helpful. Electromagnetic neuronavigation was therefore well suited to CSF diversion procedures, awake craniotomies, and cases in which rigid head fixation was undesirable, such as in neonates. This technology extends the application of neuronavigation to routine shunt placement and ventricular catheter placement in patients with traumatic brain injury.Journal of Neurosurgery 04/2009; 111(6):1179-84. DOI:10.3171/2008.12.JNS08628 · 3.15 Impact Factor