Evidence-Based Medicine ; Humans ; Neuronavigation

The interactive image-guided stereotactic system can provide a real-time surgical localization and guidance for complete removal of the tumor. However, this system has limitation with respect to the resection of deepseated tumors because once the tumor is removed, the brain and the margin of tumors shift toward the area previously occupied by the tumor. We present a new operative technique for determining the resection margin of deep-seated tumors using a visual marker called a 'tailed bullet' to overcome the problem mentioned above. Preoperative enhanced computed tomograms or magnetic resonance imagings were performed with the aid of the Leksell frame. The enhancing margin of the tumor was defined as a resection margin. Several points(10-15) of the tumor margin on the enhanced imaging were chosen and localized. After usual craniotomy, multiple tailed bullets were inserted into the target point just before the opening of the dura. As the tumor was removed, the brain began to move along with the tailed bullets, thus enable us to continue tracking the tumor margin by following the bullet's location. There are substantial benefits of this surgical technique. It can be easily applied to any kind of stereotactic frame without incurring other expenses and it is more cost-efficient than the neuronavigation system. This surgical procedure is also safe and simple to use for overcoming the limitation of neuronavigation system, since the movement of the bullets with the brain can be easily traced thus lowering the mortality and morbidity of brain tumor resection. This surgical technique is especially useful in glioma surgery.
Brain Neoplasms* ; Brain* ; Craniotomy ; Glioma ; Mortality ; Neuronavigation

OBJECTIVE: Neuroendoscopy is applied to various intracranial pathologic conditions. But this technique needs informations for the anatomy, critically. Neuronavigation makes the operation more safe, exact and lesser invasive procedures. But classical neuronavigation systems with rigid pinning fixations were difficult to apply to pediatric populations because of their thin and immature skull. Electromagnetic neuronavigation has used in the very young patients because it does not need rigid pinning fixations. The usefulness of electromagnetic neuronavigation is described through our experiences of neuroendoscopy for pediatric groups and reviews for several literatures. METHODS: Between January 2007 and July 2011, nine pediatric patients were managed with endoscopic surgery using electromagnetic neuronavigation (AxiEM, Medtronics, USA). The patients were 4.0 years of mean age (4 months-12 years) and consisted of 8 boys and 1 girl. Totally, 11 endoscopic procedures were performed. The cases involving surgical outcomes were reviewed. RESULTS: The goal of surgery was achieved successfully at the time of surgery, as confirmed by postoperative imaging. In 2 patients, each patient underwent re-operations due to the aggravation of the previous lesion. And one had transient mild third nerve palsy due to intraoperative manipulation and the others had no surgery related complication. CONCLUSION: By using electromagnetic neuronavigation, neuroendoscopy was found to be a safe and effective technique. In conclusion, electromagnetic neuronavigation is a useful adjunct to neuroendoscopy in very young pediatric patients and an alternative to classical optical neuronavigation.
Humans ; Magnets ; Neuroendoscopy ; Neuronavigation ; Oculomotor Nerve Diseases ; Pediatrics ; Skull

The Viewing Wand is a frameless stereotactic device to provide image-based intraoperative navigation, allowing accurate neurosurgical planning and procedures. The authors applied the frameless stereotactic device called "ISG Viewing Wand" to 30 cases of intracranial lesions and evaluated for its usefulness and limitation. The Viewing Wand was used in 3 cases in conjunction with CT and 27 cases with MRI. The actual error of this system after the registration was judged by the operating surgeon to be less than 2mm in CT or MR image. The useful registrations were possible in 25(83%) out of 30 cases. But it was not useful in 5 cases, because of movement of fiducial markers in 2 cases and head movement after registration in 3 cases. In 25 cases having useful registration, the wand was helpful to localize the lesion for designing the scalp incision and bone flap, as well as the extent of surgical resection of lesions. As a whole, the viewing wand was found to be reliable and accurate. The system is a useful navigational aid that allows a direct approach to intracranial pathology without the drawbacks of application and the limitations of a frame-based stereotactic device.
Fiducial Markers ; Head Movements ; Magnetic Resonance Imaging ; Neuronavigation* ; Pathology ; Scalp

In this paper, we describe a study on visualization of SW atlases. Firstly, data structures in axial, coronal and sagittal directions are generated by SW atlases' raw data after pre-processing. Secondly, we produce 3D SW atlases through setting gray intensity and spaces between slices. Thirdly, we integrate the atlas into the neurosurgery navigation system and realize the visualization of SW atlases. Finally, we realize brain anatomy structures labeling and real-time display in neurosurgery navigation system.
Anatomy, Artistic ; Brain Mapping ; Humans ; Neuronavigation ; methods ; Neurosurgery ; methods

OBJECTIVETo review the history, development, and reality of neuronavigation surgery in China and to discuss the future of neuronavigation surgery.

DATA SOURCESPubMed, the China Knowledge Resource Integrated Database, and the VIP Database for Chinese Technical Periodicals were searched for papers published from 1995 to the present with the key words "neuronavigation," functional navigation," "image-guided," and "stereotaxy." Articles were reviewed for additional citations, and some information was gathered from Web searches.

STUDY SELECTIONArticles related to neuronavigation surgery in China were selected, with special attention to application to brain tumors.

RESULTSSince the introduction of neurosurgical navigation to China in 1997, this core technique in minimally invasive neurosurgery has seen rapid development. This development has ranged from brain structural localization to functional brain mapping, from static digital models of the brain to dynamic brain-shift compensation models, and from preoperative image-guided surgery to intraoperative real-time image-guided surgery, and from application of imported equipment and technology to use of equipment and technology that possess Chinese independent intellectual property rights.

CONCLUSIONSThe development and application of neuronavigation techniques have made neurological surgeries in China more safe, precise and effective, and less invasive, and promoted the quality of Chinese neurosurgical practice to the rank of the most advance and excellence in the world.

OBJECTIVE: We compare the frameless stereotactic hematoma aspiration (FSA) with frame-based stereotactic hematoma aspiration (FBSA) in intracerebral hemorrhage (ICH) about operative advantage and result. MATERIAL AND METHODS: Between January 2002 and December 2002, we surgically treated 30 patients presenting with spontaneous ICH at our hospital. 15 patients underwent FBSA via Codman-Roberts-Wells system and catheter placement with urokinase infusion and drainage, and 15 patients underwent FSA and catheter placement via neuronavigator with urokinase infusion and drainage. RESULTS: The amount of remaining hematoma and removal rate were from 1 to 26 and 76% in FSA and from 2 to 55 and 60.4% in FBSA. The entry point was selected within 2.03+/-0.85 cm in a frontal direction from Kocher's point and 2.86+/-0.57 cm in lateral direction from Kocher's point and the trajectory was selected toward the distal margin of hematoma along the long axis of hematoma in FSA but the entry point was restricted within Kocher's point and the trajectory was selected toward the center of the maximum axial section of hematoma in FBSA. The mean time of operative preparation was mean 61 minutes in FSA and 78 minutes in FBSA. The number of patients not required with infusion of urokinase was 10 in FSA and 7 in FBSA. The mean duration of urokinase infusion was 3.6 day in FSA and 4.1 day in FBSA. CONCLUSION: FSA is fast, simple and effective procedure. In comparison with FBSA, FSA has advantage in selecting the entry point and the trajectory for hematoma aspiration and catheter placement, and in a less time-consuming procedure.
Axis, Cervical Vertebra ; Catheters ; Cerebral Hemorrhage* ; Drainage ; Hematoma* ; Humans ; Neuronavigation ; Urokinase-Type Plasminogen Activator

OBJECTIVE: To evaluate the effect of electromagnetic (EM) navigation system on ventriculoperitoneal (VP) shunt failure rate through comparing the result of standard shunt placement. METHODS: All patients undergoing VP shunt from October 2007 to September 2010 were included in this retrospective study. The first group received shunt surgery using EM navigation. The second group had catheters inserted using manual method with anatomical landmark. The relationship between proximal catheter position and shunt revision rate was evaluated using postoperative computed tomography by a 3-point scale. 1) Grade I; optimal position free-floating in cerebrospinal fluid, 2) Grade II; touching choroid or ventricular wall, 3) Grade III; tip within parenchyma. RESULTS: A total of 72 patients were participated, 27 with EM navigated shunts and 45 with standard shunts. Grade I was found in 25 patients from group 1 and 32 patients from group 2. Only 2 patients without use of navigation belonged to grade III. Proximal obstruction took place 7% in grade I, 15% in grade II and 100% in grade III. Shunt revision occurred in 11% of group 1 and 31% of group 2. Compared in terms of proximal catheter position, there was growing trend of revision rate according to increase of grade on each group. Although infection rate was similar between both groups, the result had no statistical meaning (p=0.905, chi-square test). CONCLUSION: The use of EM navigation in routine shunt surgery can eliminate poor shunt placement resulting in a dramatic reduction in failure rates.
Catheters ; Choroid ; Humans ; Hydrocephalus ; Hypogonadism ; Magnets ; Mitochondrial Diseases ; Neuronavigation ; Ophthalmoplegia ; Retrospective Studies ; Ventriculoperitoneal Shunt

A 47-year-old man presented with a subarachnoid hemorrhage (SAH) and right cerebellar hematoma was referred for evaluation. Cerebral angiography revealed a distal anterior inferior cerebellar artery (AICA) aneurysm associated with an arteriovenous malformation (AVM). Successful obliteration and complete removal of the aneurysm and AVM were obtained using transcortical approach under the guidance of neuronavigation system. The association of a peripheral AICA aneurysm and a cerebellar AVM by the same artery is unique. The reported cases of conventional surgery for this disease complex are not common and their results are variable. Less invasive surgery using image-guided neuronavigation system would be helpful and feasible for a peripheral aneurysm combining an AVM of the posterior fossa in selective cases.
Aneurysm ; Arteries ; Arteriovenous Malformations ; Cerebral Angiography ; Hematoma ; Humans ; Middle Aged ; Neuronavigation ; Subarachnoid Hemorrhage

OBJECTIVE: Neurosurgical technique has recently entered a fantastic era of image guided surgery or neuronavigaton and application of this technology is beginning to have a significant impact on a variety of intracranial procedures. This study purports to investigate the effectiveness of this new technique in its application to the brain tumor surgery. METHODS: We used the BrainLab VectorVision neuronavigation system, which is an intraoperative, imageguided, frameless, and localization system. We operated 220 cases of different brain pathological conditions with its guidance. RESULTS: The mean of target localizing accuracy, mass size, and mass volume were 1.14mm, 3.04x3.78cm, 32.04cc respectively. These cases included 194 microsurgical craniotomies, 21 frameless stereotactic biopsies, 4 endoscopic procedure and 1 catheter placement. The common pathological diagnoses were meningioma in 61 cases, glioma in 59 and metastasis in 45. CONCLUSION: The neuronavigation system has shown to be very effective and user-friendly for routine microsurgical interventions. The application of this technique not only revealed benefits in operative planning, appreciation of anatomy, lesion location, and safety of surgery, but also greatly enhanced surgical confidence. The image guided surgical technology has a great potential to play an important role in contemporary neurosurgery and its various adoptions in practice will be realized in the near future.
Biopsy ; Brain Neoplasms* ; Brain* ; Catheters ; Craniotomy ; Diagnosis ; Glioma ; Meningioma ; Neoplasm Metastasis ; Neuronavigation* ; Neurosurgery ; Surgery, Computer-Assisted