Articles: neuronavigation.
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Case Reports
Interhemispheric approach for endoscopic ligation of an anterior cranial fossa dural arteriovenous fistula.
We describe the endoscopic ligation of an anterior cranial fossa (ACF) dural arteriovenous fistula (DAVF) through an interhemispheric approach. Intracranial DAVF of the ACF are rare and associated with an aggressive natural history, due to their ubiquitous direct cortical venous drainage and frequent coincidence of venous ectasia. Although surgical ligation is the preferred treatment for ACF DAVF, the role of endoscopy in the surgical management of DAVF is undefined. ⋯ After dissecting along the draining vein to the point of fistulization, the proximal portion of the draining vein was ligated. Intraoperative angiography confirmed complete obliteration of the DAVF, and the patient was asymptomatic at the 6 week postoperative follow-up. Endoscopy provides excellent visualization of ACF DAVF and can safely facilitate surgical treatment in appropriately selected patients with these lesions.
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One of the main challenges during skull base tumor surgery is identifying the relationships between the lesion and the principal intracranial vessels. To this end, neuronavigation systems based on preoperative imaging lack accuracy because of brain shift and brain deformation. Intraoperative navigated B-mode ultrasonography is useful in defining the extent of brain tumor. Doppler imaging adds information regarding flow entity in neighboring vessels. Second-generation ultrasound contrast agents improve the signal-to-noise ratio of B-mode imaging and permit the study of the vessel's course, blood flow, and perfusion characteristics of focal lesions. We report our experience using intraoperative navigated contrast-enhanced ultrasound to perform a navigated angiosonography (N-ASG) for the visualization of vessels in a series of 18 skull base tumors. ⋯ N-ASG can be applied to skull base tumor surgery, providing helpful information about the relationship between principal intracranial vessels and tumors. This technique could be of assistance in approaching the tumor and avoiding vascular damages.
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Complete surgical resection is known to provide the best prognosis when treating complex tumors of the spine. The anatomy of the cervical spine and the extensive involvement often present by the time these lesions are discovered can make total resection challenging. A novel technique combining preoperative and intraoperative imaging for intraoperative navigation can serve as an additional tool for facilitating tumor resection. ⋯ Preoperative MRI coregistered and merged with intraoperative CT may serve as a useful intraoperative imaging modality for facilitating safe and complete resection of complex spine tumors.
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Intraoperative magnetic resonance imaging is the gold standard among image-guided techniques for glioma surgery. Scant data are available on the role of intraoperative computed tomography (i-CT) in high-grade glioma (HGG) surgery. ⋯ EOTR, extent of tumor resectionGTR, gross total resectionHGG, high-grade gliomai-CT, intraoperative computed tomographyi-MRI, intraoperative magnetic resonance imagingKPS, Karnofsky Performance StatusOS, overall survivalPFS, progression-free survival.
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The current neurosurgical goal for patients with malignant gliomas is maximal safe resection of the contrast-enhancing tumor. However, a complete resection of the contrast-enhancing tumor is achieved only in a minority of patients. One reason for this limitation is the difficulty in distinguishing viable tumor from normal adjacent brain during surgery at the tumor margin using conventional white-light microscopy. ⋯ Consequently, 5-ALA FGS has become an indispensable surgical technique and standard of care at many neurosurgical departments around the world. We conducted an extensive literature review concerning the surgical benefit of using 5-ALA for FGS of malignant gliomas. According to the literature, there are a number of reasons for the neurosurgeon to perform 5-ALA FGS, which will be discussed in detail in the current review.