RESUMEN
BACKGROUND AND IMPORTANCE: Complete posterior atlantoaxial dislocation (PAAD) with an unfractured odontoid process is a rare condition where a dislocated but intact odontoid process is positioned ventrally to the anterior arch of C1. This lesion is related to transverse and alar ligament rupture secondary to hyperextension and rotatory traumatic injury and is often associated with neurological deficit. The treatment strategy remains controversial, and in many cases, odontoidectomy is required. Traditional approaches for odontoidectomy (transnasal and transoral) are technically demanding and are related to several complications. This article describes a 360° reduction and stabilization technique through a navigated anterior full-endoscopic transcervical approach (nAFETA) as a novel technique for odontoidectomy and C1-C2 anterior transarticular fixation supplemented with posterior fusion. CLINICAL PRESENTATION: A 21-year-old man presented to the emergency room by ambulance after a motorcycle accident. On evaluation, incomplete ASIA B spinal cord injury was documented. Imaging revealed a complete PAAD. We performed a two-staged procedure, a nAFETA odontoidectomy plus C1-C2 anterior transarticular fixation followed by posterior C1-C2 wired fusion. At a 2-year follow-up, the patient had a 10-point Oswestry Disability Index score and neurological improvement to ASIA E. CONCLUSION: PAAD can be successfully treated through minimally invasive nAFETA. Noteworthy, the risks of the transoral and endonasal routes were avoided through this approach. In addition, nAFETA allows anterior transarticular fixation during the same procedure providing spinal stability. Further studies are required to expand the use of nAFETA in this field.
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Articulación Atlantoaxoidea , Luxaciones Articulares , Apófisis Odontoides , Humanos , Masculino , Luxaciones Articulares/cirugía , Luxaciones Articulares/diagnóstico por imagen , Articulación Atlantoaxoidea/cirugía , Articulación Atlantoaxoidea/diagnóstico por imagen , Apófisis Odontoides/cirugía , Apófisis Odontoides/lesiones , Apófisis Odontoides/diagnóstico por imagen , Adulto Joven , Fusión Vertebral/métodos , Endoscopía/métodos , Resultado del Tratamiento , Neuronavegación/métodos , Neuroendoscopía/métodosRESUMEN
BACKGROUND: Image-guided surgery has shown great utility in neurosurgery, especially in allowing for more accurate surgical planning and navigation. The current gold standard for image-guided neurosurgery is neuronavigation, which provides millimetric accuracy on such tasks. However, these approaches often require a complicated setup and have high cost, hindering their potential in low- and middle-income countries. The aim of this study was to develop and evaluate the performance of a mobile-based augmented reality neuronavigation solution under different conditions in a preclinical environment. METHODS: The application was developed using the Swift programming language and was tested on a replica of a human scalp under variable lighting, with different numbers of registration points and target point position conditions. For each condition, reference points were input into the application, and the target points were computed for 10 iterations. The mean registration error and target error were used to assess the performance of the application. RESULTS: In the best-case scenario, the proposed solution had a mean target error of 2.6 ± 1.6 mm. CONCLUSIONS: Our approach provides a viable, low-cost, easy-to-use, portable method for locating points on the scalp surface with an accuracy of 2.6 ± 1.6 mm in the best-case scenario.
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Realidad Aumentada , Neurocirugia , Cirugía Asistida por Computador , Humanos , Neuronavegación/métodos , Procedimientos Neuroquirúrgicos/métodos , Cirugía Asistida por Computador/métodos , Neurocirugia/métodosRESUMEN
Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as '5-ALA free' or '5-ALA residual'. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the '5-ALA free' resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease.
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Neoplasias Encefálicas/cirugía , Cirugía Asistida por Computador/métodos , Ácido Aminolevulínico , Microscopía Fluorescente/métodos , Cuidados Posoperatorios , Neoplasias Encefálicas/patología , Cuidados Preoperatorios , Estudios Retrospectivos , Neuronavegación/métodos , Cerebro/cirugía , Cerebro/patología , Cuidados Intraoperatorios , América Latina/epidemiologíaRESUMEN
Objective The purpose of the present study is to demonstrate the usefulness of intraoperative ultrasound guidance as a technique for the assessment, in real time, of tumor resection and as a navigation aid during intra-axial brain lesion removal on patients admitted in the Neurosurgical Department at the Hospital Universitario de Caracas, Caracas, Venezuela, in 2018. Methods A total of 10 patients were enrolled, each with intra-axial brain lesions with no previous neurosurgical procedures and a mean age of 49 years old, ranging from 29 to 59 years old. Results A male predominance was observed with 7 cases (70%) over 3 female cases (30%). Six patients had lesions in the dominant hemisphere. The frontal lobe was the most commonly affected,with 5 cases, followed by the parietal lobe,with 4 cases. After craniotomy, ultrasound evaluation was performed previously to dural opening, during tumor resection and after tumor removal. The mean tumor size in axial, coronal and sagittal views was 3.72 cm, 3.08 cm and 3.00 cm, respectively, previously to dural opening with intraoperative ultrasound. The average tumor depth was 1.73 cm from the cerebral cortex. The location and removal duration from the beginning of the approach (ultrasound usage time) was 83.60 minutes, and the average surgery duration was 201 minutes. Navigation with intraoperative ultrasound served to resect intra-axial tumors more precisely and safely. There was no postoperative complication associated with the surgery in this series of cases. Conclusions Intraoperative ultrasound guidance for intra-axial subcortical tumor resection is a technique that serves as a surgical and anatomical orientation tool.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Neoplasias Encefálicas/cirugía , Monitoreo Intraoperatorio/métodos , Ultrasonografía , Neuronavegación/métodos , Glioma/cirugía , Neoplasias Encefálicas/diagnóstico por imagen , Epidemiología Descriptiva , Procedimientos Neuroquirúrgicos/métodos , Craneotomía/métodos , Glioma/fisiopatología , Glioma/diagnóstico por imagenRESUMEN
Introduction The precise identification of anatomical structures and lesions in the brain is the main objective of neuronavigation systems. Brain shift, displacement of the brain after opening the cisterns and draining cerebrospinal fluid, is one of the limitations of such systems. Objective To describe a simple method to avoid brain shift in craniotomies for subcortical lesions. Method We used the surgical technique hereby described in five patients with subcortical neoplasms. We performed the neuronavigation-guided craniotomies with the conventional technique. After opening the dura and exposing the cortical surface, we placed two or three arachnoid anchoring sutures to the dura mater, close to the edges of the exposed cortical surface. We placed these anchoring sutures under microscopy, using a 60 mononylon wire. With this technique, the cortex surface was kept close to the dura mater, minimizing its displacement during the approach to the subcortical lesion. In these five cases we operated, the cortical surface remained close to the dura, anchored by the arachnoid sutures. All the lesions were located with a good correlation between the handpiece tip inserted in the desired brain area and the display on the navigation system. Conclusion Arachnoid anchoring sutures to the duramater on the edges of the cortex area exposed by craniotomy constitute a simple method to minimize brain displacement (brain-shift) in craniotomies for subcortical injuries, optimizing the use of the neuronavigation system.
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Espacio Subaracnoideo/cirugía , Técnicas de Sutura , Craneotomía/métodos , Neuronavegación/métodos , Cerebro/cirugíaRESUMEN
Background Neuroendoscopy is gaining popularity and is reaching new realms. Young neurosurgeons are exploring the various possibilities associated with the use of neuroendoscopy. Neuroendoscopy in excision of parenchymal brain tumors is less explored, and young neurosurgeons should be aware of the realities. The present article is an approach to put forward the difficulties faced by a young neurosurgeon and the lessons learnt. Objective To report the experience of surgical excision of parenchymal brain tumors, in selected cases, using pure endoscopic approach and to discuss its feasibility, technical benefits, risks and comparison with conventional microscopic excision. Method Eight patients of variable age group with parenchymal brain tumors were operated upon by a single surgeon and followed up for a period varying from6months to 2 years. Data regarding operating time, illumination, clarity of the field, size of craniotomy, blood loss and course of recovery was evaluated. All of the tumors were resected using rigid high definition zero and 30° endoscope. Results Out of eight cases, seven had lesions in the supratentorial and one in the infratentorial location. The age group ranged from 27 to 74 years old. Near to gross total resection was achieved in all except two cases. All of the patients recovered well without any significant morbidity or mortality. Hospital stay was reduced by 1 day on average. Conclusion Excision of parenchymal brain tumors via pure endoscopic method is a safe and efficient procedure. Although there is an initial period of learning curve, it is not steep for those already practicing neuroendoscopy, but the approach has its advantages.
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Neoplasias Encefálicas/cirugía , Neuroendoscopía/efectos adversos , Neuroendoscopía/métodos , Tejido Parenquimatoso/cirugía , Neuronavegación/métodos , EndoscopíaRESUMEN
INTRODUCTION: Diffuse gliomas are brain neoplasms with an infiltrative growing pattern to cortical and subcortical structures, frequently adjacent to eloquent areas; direct cortical and subcortical stimulation in awake craniotomy is a useful tool to achieve a gross total resection with the least neurological deficit. PRESENTATION OF CASES: A 24 years old male presented with tonic-clonic seizures. The magnetic resonance imaging (MRI) showed a left parietal glioma. Awake craniotomy was performed using neuronavigation system and brain mapping with cortical and subcortical stimulation. Functional areas were found at the rostral margin of the tumor; however, the rest of the tumor was almost totally resected. Patient was discharged without neurological deficit. A 29 years old male presented in two occasions generalized tonic-clonic seizures, with right hemiparesis. The MRI showed a left parietal glioma. Awake craniotomy was performed using neuronavigation system and brain mapping with cortical and subcortical stimulation, achieving a gross total resection. Patient was discharged without neurological deficit. CONCLUSIONS: Awake craniotomy with brain mapping by cortical and subcortical stimulation and neuronavigation, are the best assets to treat diffuse gliomas and achieve a gross total resection, ensuring the major disease-free interval and preserving the function of eloquent areas.
INTRODUCCIÓN: Los gliomas difusos son neoplasias cerebrales con un patrón de crecimiento infiltrativo, frecuentemente adyacentes a áreas elocuentes. El mapeo cerebral con estimulación cortico-subcortical con el paciente despierto es una herramienta útil para lograr la mayor resección con el menor déficit posoperatorio. PRESENTACIÓN DE CASOS: Varón de 24 años con crisis tónico-clónicas. La resonancia magnética (RM) mostró un glioma parietal izquierdo. Se realizó cirugía con el paciente despierto y mapeo cerebral por estimulación cortical y subcortical directa. Se obtuvo una resección casi total, ya que se encontraron áreas fucionales en el borde rostral del tumor. El paciente egresó sin déficit neurológico. Varón de 29 años que presenta crisis tónico-clónicas generalizadas, acompañadas de hemiparesia derecha. La RM reportó un glioma parietal izquierdo. Se realizó cirugía con el paciente despierto y mapeo cerebral por estimulación cortical y subcortical directa. Se logró una resección total y el paciente egresó sin déficit. CONCLUSIONES: La cirugía con el paciente despierto con mapeo por estimulación directa y neuronavegación es la mejor opción en el tratamiento de los gliomas difusos, para lograr una resección máxima tumoral asegurando un mayor tiempo libre de enfermedad y la conservación de la función de áreas elocuentes.
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Mapeo Encefálico , Neoplasias Encefálicas/fisiopatología , Neoplasias Encefálicas/cirugía , Glioma/fisiopatología , Glioma/cirugía , Vigilia , Adulto , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/patología , Craneotomía/métodos , Supervivencia sin Enfermedad , Glioma/diagnóstico por imagen , Glioma/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Neuronavegación/métodos , Convulsiones/etiología , Adulto JovenRESUMEN
Chordomas are locally aggressive malignant tumors due to their recurrence potential and originate from embryonic notochord remnants. Chordomas can originate anywhere on the axial skeleton. They are extradural and spread by bone destruction. Chordomas are locally aggressive tumors that invade the dura mater, and may also present with secondary intradural growth. The Meckel's cave location of chordomas has been very rarely reported in the literature. Chordomas located in Meckel's cave can be radiologically confused with trigeminal schwannomas. Herein, we report a case of Meckel's cave chordoma that was successfully excised through neuronavigation-guided endoscopic endonasal excision, a technique commonly used in skull base surgeries.
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Cordoma/cirugía , Cavidad Nasal/cirugía , Neurilemoma/cirugía , Neuroendoscopía/métodos , Neuronavegación/métodos , Adulto , Cordoma/complicaciones , Cordoma/diagnóstico por imagen , Femenino , Humanos , Cavidad Nasal/diagnóstico por imagen , Recurrencia Local de Neoplasia/complicaciones , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/cirugía , Neurilemoma/complicaciones , Neurilemoma/diagnóstico por imagen , Procedimientos Neuroquirúrgicos/métodosRESUMEN
OBJECTIVE: To describe and compare surgical exposure through microsurgical cadaveric dissection of the intercollicular region afforded by the median, paramedian, and extreme-lateral supracerebellar infratentorial (SCIT) approaches. METHODS: Ten cadaveric heads were dissected using SCIT variant approaches. A neuronavigation system was used to determine tridimensional coordinates for the intercollicular zone in each route. The areas of surgical and angular exposure were evaluated and determined by software analysis for each specimen. RESULTS: The median surgical exposure was similar for the different craniotomies: 282.9 ± 72.4 mm2 for the median, 341.2 ± 71.2 mm2 for the paramedian, and 312.0 ± 79.3 mm2 for the extreme-lateral (P = 0.33). The vertical angular exposure to the center of the intercollicular safe entry zone was also similar between the approaches (P = 0.92). On the other hand, the horizontal angular exposure was significantly wider for the median approach (P < 0.001). CONCLUSIONS: All the SCIT approaches warrant a safe route to the quadrigeminal plate. Among the different variants, the median approach had the smallest median surgical area exposure but presented superior results to access the intercollicular safe entry zone.
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Cerebelo/cirugía , Craneotomía , Neuronavegación , Procedimientos Neuroquirúrgicos , Cadáver , Craneotomía/métodos , Disección/métodos , Humanos , Microcirugia/efectos adversos , Microcirugia/métodos , Neuronavegación/efectos adversos , Neuronavegación/métodos , Procedimientos Neuroquirúrgicos/métodosRESUMEN
BACKGROUND: Despite the latest developments in microsurgery, electrophysiological monitoring, and neuroimaging, the surgical management of intrinsic brainstem lesions remains challenging. Several safe entry points have been described to access the different surfaces of the brainstem. Knowledge of this entry zone anatomy is critical to performing a safe and less morbid approach. To access the anterior midbrain surface, a well-known entry point is the anterior mesencephalic (AM) zone. Our aim was to quantify surgical AM zone exposure through the orbitozygomatic (OZ) and subtemporal (ST) approaches. We also analyzed the angular exposure along the horizontal and vertical axis angles for the AM zone. METHODS: Ten cadaveric heads were dissected using the OZ and ST approaches for anterior midbrain surface exposure. A neuronavigation system was used to determine the 3-dimensional coordinates. The area of surgical exposure, angular exposure, and anatomical limits of each craniotomy were evaluated and determined using software analysis and compared for intersection areas and AM safe zone exposure. RESULTS: The median surgical exposure was 164.7 ± 43.6 mm2 for OZ and 369.8 ± 70.1 mm2 for ST (P = 0.001). The vertical angular exposure was 37.7° ± 9.92° for the OZ and 18.4° ± 2.8° for the ST opening (P < 0.001). The horizontal angular exposure to the AM zone was 37.9° ± 7.3° for the OZ and 47.0° ± 3.2° for the ST opening (P = 0.002). CONCLUSIONS: Although the OZ craniotomy offers reduced surgical exposure, it provides a better trajectory to the AM zone compared with the ST approach.
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Craneotomía/métodos , Mesencéfalo/cirugía , Microcirugia/métodos , Cadáver , Disección/métodos , Humanos , Neuronavegación/métodosRESUMEN
BACKGROUND: Preoperative recognition of the anatomic individualities of each patient can help to achieve more precise and less invasive approaches. It also may help to anticipate potential complications and intraoperative difficulties. Here we describe the use, accuracy, and precision of a free tool for planning microsurgical approaches using 3-dimensional (3D) reconstructions from magnetic resonance imaging (MRI). METHODS: We used the 3D volume rendering tool of a free open-source software program for 3D reconstruction of images of surgical sites obtained by MRI volumetric acquisition. We recorded anatomic reference points, such as the sulcus and gyrus, and vascularization patterns for intraoperative localization of lesions. Lesion locations were confirmed during surgery by intraoperative ultrasound and/or electrocorticography and later by postoperative MRI. RESULTS: Between August 2015 and September 2016, a total of 23 surgeries were performed using this technique for 9 low-grade gliomas, 7 high-grade gliomas, 4 cortical dysplasias, and 3 arteriovenous malformations. The technique helped delineate lesions with an overall accuracy of 2.6 ± 1.0 mm. 3D reconstructions were successfully performed in all patients, and images showed sulcus, gyrus, and venous patterns corresponding to the intraoperative images. All lesion areas were confirmed both intraoperatively and at the postoperative evaluation. CONCLUSIONS: With the technique described herein, it was possible to successfully perform 3D reconstruction of the cortical surface. This reconstruction tool may serve as an adjunct to neuronavigation systems or may be used alone when such a system is unavailable.
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Imagenología Tridimensional , Neuronavegación , Programas Informáticos , Adulto , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Angiografía Cerebral , Corteza Cerebral/irrigación sanguínea , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/cirugía , Femenino , Glioma/diagnóstico por imagen , Glioma/cirugía , Humanos , Imagenología Tridimensional/métodos , Malformaciones Arteriovenosas Intracraneales/diagnóstico por imagen , Malformaciones Arteriovenosas Intracraneales/cirugía , Imagen por Resonancia Magnética , Masculino , Malformaciones del Desarrollo Cortical/diagnóstico por imagen , Malformaciones del Desarrollo Cortical/cirugía , Neuronavegación/métodos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos XAsunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Neuronavegación/métodos , Enfermedades de la Columna Vertebral/cirugía , Humanos , Imagenología Tridimensional/métodos , Imagenología Tridimensional/normas , Procedimientos Quirúrgicos Mínimamente Invasivos/normas , Neuronavegación/normas , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Cirugía Asistida por Computador/métodos , Cirugía Asistida por Computador/normasRESUMEN
El linfangioma es un tumor benigno raro y predominante en la infancia, debido a su crecimiento puede comprometer al órgano donde se desarrolla, se han propuesto varias opciones de trata-miento, sin embargo, la cirugía continúa siendo la primera opción. La neuronavegación permite realizar exéresis con gran precisión y de utilidad en cirugía ocular, por lo que disminuye el riesgo de secuelas después de una exéresis de linfangioma orbitario.
Lymphangioma is a benign tumor predominantly in childhood, due to growth that can compromise the organ where it grows. Several treatment options, have been proposed however,surgery remains the first choice. Neuronavigation allows successful excision and use in eye surgery,which decreases the risk of sequels following excision of orbital lymphangioma.
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Humanos , Femenino , Preescolar , Neoplasias Orbitales/cirugía , Cirugía Asistida por Computador/métodos , Neuronavegación/métodos , Linfangioma/cirugía , Neoplasias Orbitales/diagnóstico por imagen , Imagenología Tridimensional/métodos , Linfangioma/diagnóstico por imagenRESUMEN
INTRODUCTION: In the field of Glioma surgery, there has been an increasing interest in the use of assistive technologies to overcome the difficulty of preserving brain function while improving surgical radicality. In most reports, tumor localization has seldom been considered a variable and the role of intraoperative adjuncts is yet to be determined for gliomas of the insula. OBJECTIVES: To evaluate the efficacy of fluorescence-guided resection with 5-ALA, intraoperative neurophysiological monitoring (IOM), neuronavigation, and tractography in the Extent of Resection (EOR), functionality scores, overall survival (OS) and progression-free survival (PFS) in a retrospective cohort of insular gliomas. METHODS: We reviewed all cases of insular tumors operated on at the Department of Neurosurgery, University Hospital of Tübingen - Germany, between May 2008 and November 2013. EOR was determined by volumetric analysis. Mann Whitney, Chi-square and Kaplan Meier functions were used for assessment of each technology's effect on primary and secondary outcomes. RESULTS: 28 cases (18 men (64%) and 10 women (36%); median age at diagnosis: 52.5 years, range 12 - 59) were considered eligible for analysis. High grade and low grade gliomas accounted for 20 (71%) and 8 (29%) cases, respectively. The most used technologies were IOM (64%) and Neuronavigation (68%). 5-ALA was the only technique associated with EOR ≥90% (p=0.05). Tractography determined improvement in the Karnofsky Performance Scale (50% vs. 5% cases improved, p=0.02). There was a positive association between the use of neuronavigation and overall survival (23 vs. 27.4 months, p=0.03), but the use of 5-ALA was associated with shorter OS (34.8 vs. 21.1 months, p=0.01) and PFS (24.4 vs. 11.8, p=0.01). CONCLUSIONS: We demonstrate for the first time that for insular gliomas 5-ALA plays a role in achieving higher EOR, although this technology was associated with poor OS and PFS; also tractography and neuronavigation can be of great importance in the treatment of insular gliomas as they determined better functionality and OS in this study, respectively. Prospective studies with a more prominent sample and proper multivariate analysis will help determine the real benefit of these adjuncts in the setting of insular gliomas.
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Ácido Aminolevulínico , Neoplasias Encefálicas/cirugía , Corteza Cerebral/cirugía , Imagen de Difusión Tensora/métodos , Glioma/cirugía , Monitorización Neurofisiológica Intraoperatoria/métodos , Neuronavegación/métodos , Evaluación de Resultado en la Atención de Salud/métodos , Fármacos Fotosensibilizantes , Adolescente , Adulto , Niño , Supervivencia sin Enfermedad , Femenino , Humanos , Estado de Ejecución de Karnofsky , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
Objective In recent years, technologies have advanced considerably in improving surgical outcome following treatment of lesions in eloquent brain areas. The aimof this study is to explore which method is best in the resection of motor area lesions. Methods Prospective, non-randomized study Evaluate on 74 patients who underwent surgery to remove lesions around the motor area. Results Total lesion removal was achieved in 68 patients (93.1%). Fifty-four patients (73.9%) presented normal motor function in the preoperative period; of these, 20 (37.3%) developed transitory deficits. Nevertheless, 85% of these patients later experienced a complete recovery. Nineteen patients presented with motor deficits preoperatively; of these, five presented deteriorating motor abilities. Intraoperative stimulation methods were used in 65% of the patients, primarily in cases of glioma. Conclusions The morbidity in patients submitted to resections of motor area lesions is acceptable and justify the surgical indication with the purpose of maximal resection. Intraoperative stimulation is an important tool that guides glioma resection in many cases.
Objetivo Nos últimos anos, consideráveis avanços tecnológicos têm surgido no sentido de melhorar os resultados cirúrgicos no tratamento de lesões em áreas eloquentes do cérebro. O objetivo deste estudo é investigar qual o melhor método para ressecção de lesões em área motora. Método Estudo prospectivo não aleatório que avaliou os resultados pós-operatórios em 74 pacientes submetidos à ressecção de lesões em área motora ou adjacente. Resultados A ressecção cirúrgica foi considerada total em 68 (93,1%) pacientes. 54 pacientes (73,9%) apresentavam força muscular normal no pré-operatório. Destes, 20 (37,3%) apresentaram déficit no pós-operatório imediato, sendo que 17 (85%) recuperaram completamente o déficit. 19 pacientes apresentavam déficit no préoperatório, sendo que 05 apresentaram piora do déficit no pós-operatório imediato. A estimulação intraoperatória foi utilizada em 65% dos casos, principalmente nos gliomas. Conclusão Amorbidade empacientes operados de lesões emáreamotora é bastante aceitável e justifica a indicação cirúrgica com objetivo de ressecção máxima. A estimulação intraoperatória é uma ferramenta importante para guiar a resseção dos gliomas em muitos casos.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Cuidados Posoperatorios , Cuidados Preoperatorios , Trastornos Motores/diagnóstico , Corteza Insular/lesiones , Cuidados Intraoperatorios , Corteza Motora/lesiones , Estudios Prospectivos , Interpretación Estadística de Datos , Resultado del Tratamiento , Craneotomía/métodos , Neuronavegación/métodosRESUMEN
OBJECTIVE: Evaluate the feasibility of an adequate exposure with anatomical preservation of labyrinth structures through retrosigmoid transmeatal approach (RSA) in surgeries for resection of acoustic neuromas/vestibular schwannomas (VS). METHOD: Thirty patients underwent surgical resection and were preoperatively evaluated with fine slice high definition CT scans and 3D-MRI volumetric reconstructions. Extension of internal auditory canal (IAC) opening during surgery was measured using 3 mm right-angle calibrated hook and neuronavigation parameters. Postoperatively, the extension of IAC opening and integrity of the labyrinth were confirmed through preoperatively images procedures. RESULTS: The preoperative length of IACs varied between 7.8 and 12.0 mm (mean 9.3 mm, SD 0.98, 95%CI 8.9 to 9.6, and median 9.0 mm). Postoperative images demonstrated adequate opening of the IAC and semicircular channels integrity. CONCLUSION: A complete drilling of the posterior wall of IAC through the RSA is feasible and allows direct visualization of the IAC-fundus without damaging the semicircular canals.
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Oído Interno/cirugía , Neuroma Acústico/cirugía , Tratamientos Conservadores del Órgano/métodos , Canales Semicirculares/anatomía & histología , Estudios de Factibilidad , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Microcirugia/métodos , Persona de Mediana Edad , Neuroma Acústico/patología , Neuronavegación/métodos , Procedimientos Quirúrgicos Otológicos/métodos , Periodo Posoperatorio , Estudios Prospectivos , Reproducibilidad de los Resultados , Canales Semicirculares/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Carga TumoralRESUMEN
Objective Evaluate the feasibility of an adequate exposure with anatomical preservation of labyrinth structures through retrosigmoid transmeatal approach (RSA) in surgeries for resection of acoustic neuromas/vestibular schwannomas (VS). Method Thirty patients underwent surgical resection and were preoperatively evaluated with fine slice high definition CT scans and 3D-MRI volumetric reconstructions. Extension of internal auditory canal (IAC) opening during surgery was measured using 3 mm right-angle calibrated hook and neuronavigation parameters. Postoperatively, the extension of IAC opening and integrity of the labyrinth were confirmed through preoperatively images procedures. Results The preoperative length of IACs varied between 7.8 and 12.0 mm (mean 9.3 mm, SD 0.98, 95%CI 8.9 to 9.6, and median 9.0 mm). Postoperative images demonstrated adequate opening of the IAC and semicircular channels integrity. Conclusion A complete drilling of the posterior wall of IAC through the RSA is feasible and allows direct visualization of the IAC-fundus without damaging the semicircular canals. .
Objetivo Avaliar a possibilidade de exposição adequada preservando anatomia das estruturas labirínticas pelo acesso retrosigmóide-transmeatal (RSA) nas ressecções de schwannomas do vestibular (VS). Método Trinta pacientes foram submetidos à ressecção cirúrgica e avaliados no pré-operatório com tomografias de alta definição e reconstruções de ressonância magnética 3D. A extensão da abertura do conduto auditivo interno (CAI) foi medida e confirmada com parâmetros de neuronavegação. No pós-operatório, a extensão da abertura e a integridade do labirinto foram confirmadas por imagens de tomografia computadorizada. Resultados A extensão do CAI no pré-operatório apresentou variação de 7,8-12 mm (média 9,3 mm, DP 0,98, IC95% de 8,9-9,6 e mediana 9 mm). Imagens pós-operatórias demonstraram abertura adequada do IAC e integridade dos canais semicirculares. Conclusão A abertura completa da parede posterior do CAI pelo RSA é possível e permite a visualização direta do fundo do conduto sem prejudicar os canais semicirculares. .
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Oído Interno/cirugía , Neuroma Acústico/cirugía , Tratamientos Conservadores del Órgano/métodos , Canales Semicirculares/anatomía & histología , Estudios de Factibilidad , Imagen por Resonancia Magnética/métodos , Microcirugia/métodos , Neuroma Acústico/patología , Neuronavegación/métodos , Procedimientos Quirúrgicos Otológicos/métodos , Periodo Posoperatorio , Estudios Prospectivos , Reproducibilidad de los Resultados , Canales Semicirculares/cirugía , Resultado del Tratamiento , Carga Tumoral , Tomografía Computarizada por Rayos X/métodosRESUMEN
UNLABELLED: BACKGROUND/STUDY AIMS: Percutaneous radiofrequency trigeminal rhizotomy (RTR) is a standardized treatment for trigeminal neuralgia, yet it has been associated with serious complications related to the cannulation of the foramen ovale. Some of these complications, such as carotid injury, are potentially lethal. Neuronavigation was recently proposed as a method to increase the procedure's safety. All of the techniques described so far rely on pre- or intraoperative computed tomography scanning. Here we present a simple method based on magnetic resonance imaging (MRI) (radiation free) used to target the foramen ovale under navigation guidance. PATIENTS/MATERIAL AND METHODS: We retrospectively analyzed nine patients who had undergone navigated percutaneous RTR based solely on preoperative MRI and compared them with 35 patients who underwent conventional RTR guided by fluoroscopy. We analyzed immediate and late outcome and categorized the results into pain free, > 70% pain reduction, and persistent pain. We also compared groups in terms of the duration of the procedure and the complication rates. Here we describe the navigation method in detail and review the anatomical landmarks for target definition. RESULTS: The duration of the surgical procedure was similar in both groups (32.1 in the standard technique versus 34.5 minutes with navigation; p = 0.5157). There was no significant difference between groups regarding pain reduction at the immediate (p = 1.0) or late follow-up (p = 0.6284) time points. Furthermore, no serious complications were observed in the navigated group. CONCLUSIONS: We present a simple radiation-free method for neuronavigation-assisted percutaneous RTR. This method proved to be safe and effective, and it is especially recommended for young, inexperienced neurosurgeons.
Asunto(s)
Neuronavegación/métodos , Rizotomía/métodos , Neuralgia del Trigémino/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Several studies published to date about glioma surgery have addressed the validity of using novel technologies for intraoperative guidance and potentially improved outcomes. However, most of these reports are limited by questionable methods and/or by their retrospective nature. In this work, we performed a systematic review of the literature to address the impact of intraoperative assistive technologies on the extent of resection (EOR) in glioma surgery, compared to conventional unaided surgery. We were also interested in two secondary outcome variables: functional status and progression-free survival. We primarily used PubMed to search for relevant articles. Studies were deemed eligible for our analysis if they (1) were prospective controlled studies; (2) used EOR as their primary target outcome, assessed by MRI volumetric analysis; and (3) had a homogeneous study population with clear inclusion criteria. Out of 493 publications identified in our initial search, only six matched all selection criteria for qualitative synthesis. Currently, the evidence points to 5-ALA, DTI functional neuronavigation, neurophysiological monitoring, and intraoperative MRI as the best tools for improving EOR in glioma surgery. Our sample and conclusions were limited by the fact that studies varied in terms of population characteristics and in their use of different volumetric analyses. We were also limited by the low number of prospective controlled trials available in the literature. Additional evidence-based high-quality studies assessing cost-effectiveness should be conducted to better determine the benefits of intraoperative assistive technologies in glioma surgery.