Articles: neuronavigation.
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Neurol. Med. Chir. (Tokyo) · Jan 2010
ReviewSurgical treatment for glioma: extent of resection applying functional neurosurgery.
Current treatments for gliomas, including surgery, chemotherapy, and radiation therapy, frequently result in unsuccessful outcomes. Studies on glioma resection were reviewed to assess better treatment outcomes applying the newest neurosurgical multimodalities. We reviewed reports of surgical removal of gliomas utilizing functional brain mapping, monitoring, and other functional neurosurgery techniques such as neuronavigation and awake surgery. ⋯ However, those deficits often improved during the postoperative rehabilitation and recovery period when the essential or the compensative eloquent areas remained intact. Pre- and intraoperative application of the latest brain function analysis methods promoted safe elimination of gliomas. These methods are expected to help explore the long-term prognosis of glioma treatment and the mechanism for recovery from functional disabilities.
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Despite remarkable advancements in brain tumor surgery after the introduction of operating microscopes and neuronavigation systems, precise removal of infiltrative brain tumors such as gliomas remains difficult. In many cases, the margins of these tumors are unclear even under the microscope. Neuronavigation based on preoperative images also is unreliable after the "brain shift" phonomenon following cerebrospinal fluid (CSF) withdrawal and/or tumor removal. ⋯ Various lay-outs of the operating room and iMRI units with different magnetic field strengths ranging from 0.12T to 3.0T are currently in use. In 2006, we introduced 2 operation theaters with iMRI units, a 0.4T, relatively low (0.4T) and high (1.5T) magnetic-field strengths were installed at the Nagoya University Hospital and the Nagoya Central Hospital, one of our affiliated hospitals, respectively. In this paper, we discuss the, effectiveness of iMRI, as well as several problems associated with its application on the basis of the relevant literatures and our experience of more than 400 operations performed at the 2 different iMRI operation theaters, Brain THEATER and BrainSUITE.
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Journal of neuro-oncology · May 2009
ReviewFrame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle.
In the modern era of frameless stereotaxis (FL), the role of frame-based (FB) stereotactic needle biopsy is evolving. ⋯ Stereotactic biopsy is an effective, safe and important technique for histologic diagnosis of brain lesions, particularly for multifocal and corpus callosum lesions. Post-biopsy CT can be safely reserved for patients who demonstrate persistent bleeding through the biopsy needle. FB stereotaxy remains an important technique for the 20% with small or deep seated lesions or when it is advantageous to avoid an incision, a burr hole or general anesthesia.
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Minim Invas Neurosur · Oct 2008
ReviewAdvanced computer-aided intraoperative technologies for information-guided surgical management of gliomas: Tokyo Women's Medical University experience.
The availability of the intraoperative MRI and real-time neuronavigation has dramatically changed the principles of surgery for gliomas. Current intraoperative computer-aided technologies permit perfect localization of the neoplasm, precise estimation of its volume, and clear definition of its interrelationships with the eloquent brain structures. ⋯ Therefore, appropriate management of the wide spectrum of the intraoperative medical data and its adequate distribution between members of the surgical team for facilitation of the clinical decision-making is very important for attainment of the best possible outcome. Further progress in advanced neurovisualization, robotics, and comprehensive medical information technology has a great potential to increase the safety of the neurosurgical procedures for parenchymal brain tumors in the eloquent brain areas.
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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. ⋯ 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.