Neuronavigated surgery of intracranial cavernomas--enthusiasm for high technologies or a gold standard?

AIM: The aim of this study was to investigate the effect of neuronavigation on the following parameters: "skin incision", "craniotomy", "intraoperative anatomical orientation", "dissection guiding", "localization of the pathological formation", "assessment of the degree of resection" and "duration of surgical procedure" in resections of intracranial cavernomas and to specify the indications for neuronavigation in their surgical treatment. PATIENTS AND METHODS: The present prospective study included 20 patients with intracranial cavernomas who underwent neuronavigated surgery between March 2003 and December 2005 at the Clinic of Neurosurgery of the "St. I. Rilsky" University Hospital, Medical University, Sofia. The female/male ratio in the series was 9/11 (45%-55%). The patients' mean age was 27.96 +/- 11.61 years (age range 1.2 to 44 years). The patients were examined and followed up in a standard manner. RESULTS: Cavernous malformations were totally removed in 19 patients. One patient with thalamic cavernoma underwent navigated endoscopic biopsy. There was no morbidity or mortality associated with the method. Neuronavigation allowed precise localization and individual design of the skin incision and craniotomy. Neuronavigated intraoperative anatomical orientation, dissection guiding, localization of the pathological formation, and assessment of degree of resection were evaluated as markedly useful. They resulted in excellent surgery results and reduced operation time in comparison with the conventional surgery. CONCLUSION: In intracranial cavernomas frameless stereotaxy provides the surgeon with useful feedback in the preoperative anatomical orientation, the planning and simulation of surgical approach, the intraoperative navigation, in avoiding vital neurovascular structures, in the assessment of the degree of resection and the identification of possible residual parts. That is why cavernous malformations are among the most common indications for cranial neuronavigation.

Cranial neuronavigation--a step forward or a step aside in modern neurosurgery.

Neuronavigation is a result of the introduction and integration of high technologies into modern neurosurgery. The method is becoming increasingly available, and more than ever, its "fashionable", ungrounded application (literally, in each neurosurgical procedure) requires objective evaluation of its real usefulness. The aim of the present survey was to analyze the use of neuronavigation in the general fields of modern cranial neurosurgery. The reliability of the classical method of brain lesion localization was compared to neuronavigated localization. We studied the neuronavigation assisted interventions in tumor surgery, skull-base surgery, biopsies, neuroendoscopy, functional neurosurgery, vascular neurosurgery and surgical procedures in the proximity of functionally important cortical zones. We showed the modern tendencies in neuronavigation and outlined the social and economic aspects of neuronavigation-assisted neurosurgery. A summary of the advantages and disadvantages of frameless stereotaxy is made.

Role of neuronavigation in the resection of intracranial arteriovenous malformations.

AIM: The aim of this study was to investigate the effect of neuronavigation on the following parameters: "skin incision", "craniotomy", "intraoperative anatomical orientation", "dissection guiding", "localization of the pathological formation", "assessment of the degree of resection" and "duration of surgical procedure" in the resection of intracranial arteriovenous malformations (AVMs) and to specify the indications for application of neuronavigation in the surgical treatment of AVMs. METHODS: Five neuronavigation-assisted resections of intracranial AVMs were performed between March 2003 and December 2005 at the Clinic of Neurosurgery of St. I. Rilsky University Hospital, Medical University, Sofia. The female/male ratio in the series was 2:3 (40%:60%). The patients' mean age was 28.2 +/- 18.27 (range 10 to 56) years. The study was prospective in design. Patients were examined and followed in a standardized manner. RESULTS: Arteriovenous malformations were totally removed in all 5 cases of neuronavigation-assisted resections. We did not observe any morbidity or mortality associated with the method. Neuronavigation allowed precise localization and individual design of the skin incision and craniotomy. Neuronavigation facilitated the surgeon during intraoperative anatomical orientation. Dissection guiding, localization of the formation and assessment of the degree of resection were assessed as markedly useful. This resulted in reduced duration of surgery compared to conventional neurosurgery. CONCLUSIONS: In AVMs resection neuronavigation optimizes surgical approach by visualizing the relationship ofAVMs to the skull and various critical anatomical structures. Deep vessel components and nidus margins, especially in the vicinity of the ventricles can be identified precisely. Neuronavigation can improve the early post-operative results in cerebral AVMs reducing operating time and blood loss.