Suitability and limitations of pointer-based and microscope-based neuronavigational systems for surgical treatment of intracerebral tumours - A comparative study of 66 patients

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • S. B. Sobottka - , Department of Neurosurgery (Author)
  • G. Schackert - , TUD Dresden University of Technology (Author)
  • A. Steinmetz - , TUD Dresden University of Technology (Author)

Abstract

Frameless neuronavigational systems are a recent novelty for a precise approach to intracerebral tumours in open surgery. In this study 66 patients with a variety of intracranial tumours in various locations underwent surgical resection with neuronavigational guidance. Two different neuronavigational systems - the arm- and pointer-based ISG viewing wand and the microscope-based MKM system - were compared for four different indications. Neuronavigation was used (a) in multiple tumours, e.g. brain metastases, (b) in solitary cortical or subcortical tumours located in eloquent brain areas, e.g. motor cortex or speech region, (c) in deep- situated brain tumours, including brain stem neoplasms, and (d) in infiltratively growing tumours to define the borders of the lesion. Using taped skin markers (MKM system) and a surface-fit algorithm (viewing wand) for registration, an accuracy of 1 to 2 mm deviation was achieved, which was sufficient for removal of all of the intracranial neoplasms investigated. Both systems proved to be safe and useful surgical tools regardless of the patient's age positioning of the patient during surgery or the location of the lesion. When these two systems were compared, the viewing wand was found to be preferable for resection of multiple brain tumours located in distant operative sides and solitary tumours in eloquent brain areas; this was because of the wide range of movement of the pointing device and the possibility of 3D reconstruction of the brain surface. As the MKM system provided the option of stereotactical guidance during the operative procedure, it was found to be superior in approaching small and deep-situated lesions. In certain cases brain shifting due to early drainage of the CSF led to minor underestimation of the real depth. For the precise definement of tumour borders of intraparenchymal neoplasms both system were equally suitable. However, intrusion of brain parenchyma into the resection cavity led to minor overestimation of the real tumour size in certain large intraparenchymal tumours.

Details

Original languageEnglish
Pages (from-to)137-142
Number of pages6
JournalOnkologie
Volume21
Issue number2
Publication statusPublished - Apr 1998
Peer-reviewedYes

Keywords

Sustainable Development Goals

ASJC Scopus subject areas

Keywords

  • Computer-guided surgery, Intracerebral tumours, Minimally invasive neurosurgery, Neuronavigation