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

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.

Animals ; Brain ; pathology ; China ; Humans ; Neuronavigation ; methods ; Neurosurgical Procedures ; methods

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

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

OBJECTIVETo evaluate the effectiveness of neuronavigator-guided surgery for the resection of gliomas.

METHODSA total of 80 patients with gliomas underwent surgical treatment under the StealthStation neuronavigator to estimate the extent of the tumors. In 27 cases, the measurements of brain shifts at the dura, cortical surface and lesion margin were recorded during the operations. A technique termed "micro-catheter fence post" was used in superficial gliomas to compensate for brain shift.

RESULTSMean fiducial error and predicted accuracy in the 80 cases were 2.03 mm +/- 0.89 mm and 2.43 mm +/- 0.99 mm, respectively. The shifts at the dura, cortical surface and lesion margin were 3.44 mm +/- 2.39 mm, 7.58 mm +/- 3.75 mm, and 6.55 mm +/- 3.19 mm, respectively. Although neuronavigation revealed residual tumors, operations were discontinued in 5 cases of deep-seated gliomas. In the other 75 cases, total tumor removals were achieved in 62 (82.7%), and subtotal removals were achieved in 13 (17.3%). Post-operation, neurological symptoms were improved or unchanged in 68 cases (85.0%), and worsened in 12 (15.0%). No deaths occurred during the operations and post-operations.

CONCLUSIONSIntraoperative brain shifts mainly contribute to the fail of spatial accuracy during neuronavigator-guided glioma surgery. The "micro-catheter fence post" technique used for glioma surgery is shown to be useful for compensating for intraoperative brain shifts. This technique, thus, contributes to an increase in total tumor removal and a decrease in surgical complications.

Adolescent ; Adult ; Aged ; Brain Neoplasms ; surgery ; Female ; Glioma ; surgery ; Humans ; Male ; Middle Aged ; Neuronavigation ; instrumentation

In order to realize the visualization and real-time tracking of the instruments in surgical navigation system, we use the CAD solid model of the instruments directly or by reverse engineering, and transform the solid model to surface model. Then, the instruments, which are fixed with locator, are characterized and tested their precision. After registration between the CT model and the patient site in intra-operation, the system accurately displays the STL model of the instruments according to the tracked site and orientations. The model construction of the instruments is the base of the surgical navigation and is important to improve the security and precision of operation.
Computer Simulation ; Humans ; Models, Structural ; Neuronavigation ; Surgery, Computer-Assisted ; Surgical Instruments

BACKGROUNDDespite the presigmoid transpetrosal approach has been used by different researchers in various ways, the surgical injury rate remains high. Applying a minimally invasive keyhole idea, we devised a presigmoid transpetrosal keyhole approach (PTKA), classified and quantitatively assessed their approach to the petroclival area on a cadaver model by using a neuronavigation system.

METHODSThe presigmoid transpetrosal keyhole approach was divided into four increasingly morbidity-producing steps: retrolabyrinthine, partial labyrinthectomy with petrous apicectomy, translabyrinthine and transcochlear keyhole approaches. Six latex-injected cadaveric heads (twelve sides) underwent dissection in which a neuronavigation system was used. An area of exposure 10 cm superficial to a central target (working area) was calculated. The area of clival exposure with each subsequent dissection was also calculated.

RESULTSThe retrolabyrinthine keyhole approach (RLK) spares hearing and facial function in theory but provides for only a small window of upper clival exposure. The view afforded by partial labyrinthectomy with petrous apicectomy keyhole approach (PLPAK) provides for up to four times this exposure. The translabyrinthine keyhole approach (TLK) and transcochlear keyhole approach (TCK), although producing more morbidity, add little in terms of a larger petroclival window. However, with each step, the surgical freedom for manipulation of instruments increases.

CONCLUSIONSThe presigmoid transpetrosal keyhole approach to the petroclival area is feasible and useful. The RLK has relatively limited utility. For lesions without bone invasion, the PLPAK provides a much more versatile exposure with an excellent chance of hearing and facial nerve preservation. The TLK provides for greater versatility in treating lesions but clival exposure is not greatly enhanced. The TCK adds little in terms of intradural exposure but should be reserved for cases in which access to the petrous carotid artery is necessary.

Cadaver ; Cranial Fossa, Posterior ; surgery ; Humans ; Minimally Invasive Surgical Procedures ; methods ; Neuronavigation ; Petrous Bone ; surgery