The role of neuronavigation in intracranial endoscopic procedures. Neurosurg Rev

Department of Neurosurgery, University of Aachen, Aachen, Germany.
Neurosurgical Review (Impact Factor: 2.18). 12/2011; 35(3):351-8. DOI: 10.1007/s10143-011-0369-7
Source: PubMed


In occlusive hydrocephalus, cysts and some ventricular tumours, neuroendoscopy has replaced shunt operations and microsurgery. There is an ongoing discussion if neuronavigation should routinely accompany neuroendoscopy or if its use should be limited to selected cases. In this prospective clinical series, the role of neuronavigation during intracranial endoscopic procedures was investigated. In 126 consecutive endoscopic procedures (endoscopic third ventriculostomy, ETV, n = 65; tumour biopsy/resection, n = 36; non-tumourous cyst fenestration, n = 23; abscess aspiration and hematoma removal, n = 1 each), performed in 121 patients, neuronavigation was made available. After operation and videotape review, the surgeon had to categorize the role of neuronavigation: not beneficial; beneficial, but not essential; essential. Overall, neuronavigation was of value in more than 50% of the operations, but its value depended on the type of the procedure. Neuronavigation was beneficial, but not essential in 16 ETVs (24.6%), 19 tumour biopsies/resections (52.7%) and 14 cyst fenestrations (60.9%). Neuronavigation was essential in 1 ETV (2%), 11 tumour biopsies/resections (30.6%) and 8 cyst fenestrations (34.8%). Neuronavigation was not needed/not used in 48 ETVs (73.9%), 6 endoscopic tumour operations (16.7%) and 1 cyst fenestration (4.3%). For ETV, neuronavigation mostly is not required. In the majority of the remaining endoscopic procedures, however, neuronavigation is at least beneficial. This finding suggests integrating neuronavigation into the operative routine in endoscopic tumour operations and cyst fenestrations.

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Available from: Hans Christoph Ludwig, Feb 19, 2015
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    • "Some have adopted these adjunctive tools for assistance with burrhole placement, ventricular cannulation, and intraventricular navigation with the expectation that they will simplify the procedure and perhaps improve radiographic and clinical outcomes. Although incorporation of these tools into the procedure may prolong operative time and/or inflate surgical costs, several authors have declared their use to be of substantial benefit [12, 77–79]. Neuronavigation and/or stereotactic techniques were used in 44.1% of the cases in our study, and their use was associated with a significantly higher rate of complete or near-complete tumor resection. "
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    ABSTRACT: Introduction. Though traditional microsurgical techniques are the gold standard for intraventricular tumor resection, the morbidity and invasiveness of microsurgical approaches to the ventricular system have galvanized interest in neuroendoscopic resection. We present a systematic review of the literature to provide a better understanding of the virtues and limitations of endoscopic tumor resection. Materials and Methods. 40 articles describing 668 endoscopic tumor resections were selected from the Pubmed database and reviewed. Results. Complete or near-complete resection was achieved in 75.0% of the patients. 9.9% of resected tumors recurred during the follow-up period, and procedure-related complications occurred in 20.8% of the procedures. Tumor size ≤ 2cm (), the presence of a cystic tumor component (), and the use of navigation or stereotactic tools during the procedure () were each independently associated with a greater likelihood of complete or near-complete tumor resection. Additionally, the complication rate was significantly higher for noncystic masses than for cystic ones (). Discussion. Neuroendoscopic outcomes for intraventricular tumor resection are significantly better when performed on small, cystic tumors and when neural navigation or stereotaxy is used. Conclusion. Neuroendoscopic resection appears to be a safe and reliable treatment option for patients with intraventricular tumors of a particular morphology.
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    ABSTRACT: BACKGROUND: Cranial surgical navigation is most commonly performed by registration with fiducial markers, optic tracking, and intermittent pointer-based application. OBJECTIVE: To assess the accuracy and applicability of an advanced cranial navigation setup. METHODS: Continuous electromagnetic instrument navigation was used in 136 neurosurgical cases with a standard navigation system. A phantom head in an intraoperative magnetic resonance imaging environment was used to compare the accuracy of the advanced and standard navigation setups. RESULTS: A navigated suction device was used in 71 cases of intracranial tumor surgery and 46 cases of endoscopic transsphenoidal surgery. The ventriculoscope was navigated in 6 cases and the stereotactic biopsy needle in 4 cases. Electromagnetic tracking was used for catheter placement in 9 cases. The learning curve comprised 6 of the 136 cases during the first month of application. No significant difference was observed at the intracranial target points between the standard navigation setup using optic tracking, fiducial marker registration, and pointer and the advanced navigation setup with electromagnetic tracking, surface-based registration, and navigation of a field-detecting stylet in a standard metal suction tube when performed outside the 5-G line of the 3.0-T intraoperative magnetic resonance imaging. CONCLUSION: Continuous instrument navigation is the prerequisite for seamless integration of navigation systems into the neurosurgical operating workflow. Our data confirm that the application of preoperative imaging, surface-merge registration, and continuous electromagnetic tip-tracked instrument navigation may provide such integration without a significant reduction in accuracy compared with standard navigation. ABBREVIATIONS: EM, electromagnetic iMRI, intraoperative magnetic resonance imaging RMSE, root mean square error
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    ABSTRACT: BACKGROUND:: Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of non-communicating hydrocephalus with a high success and relatively low morbidity rate. However, vessel injury has been repeatedly reported, often with fatal outcome. Vessel injury is considered to be the most threatening complication. The use of indocyanine green (ICG) angiography has become an established tool in vascular microneurosurgery. OBJECTIVE:: We report our initial experience with endoscopic ICG angiography in ETV for intraoperative visualization of the basilar artery and its perforators to reduce the risk of vascular injury. METHODS:: Eleven patients with non-communicating hydrocephalus underwent ETV. Prior to opening of the third ventricular floor, ICG angiography was performed using a prototype neuroendoscope for intraoperative visualization of ICG fluorescence. RESULTS:: In 10 patients, ETV as well as ICG angiography was successfully performed. In one case, ICG angiography failed. Even in the presence of an opaque floor of the third ventricle (n=5), ICG angiography clearly demonstrated the course of the basilar artery and its major branches, and was considered useful. CONCLUSION:: ICG angiography has the potential to become a useful adjunct in ETV for better visualization of vessel structures, especially in the presence of aberrant vasculature, a nontranslucent floor of the third ventricle, or in case of re-operations.
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