Articles: neuronavigation.
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A definitive diagnosis of brain lesions not amenable to surgery is mainly made by stereotactic needle biopsy. The diagnostic yield and safety of the frameless versus frame-based image-guided stereotactic techniques is unclear. Our objective was to evaluate the safety and accuracy of frameless versus frame-based stereotactic brain biopsy techniques. ⋯ The frameless biopsy technique is as efficient as the frame-based brain biopsy technique with a low complication rate. Lesion volume was the only predictive factor of diagnostic yield. The minimally invasive twist drill technique is safe and efficient.
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Brain shift may cause significant error in neuronavigation, leading the surgeon to possible mistakes. Intraoperative magnetic resonance imaging (MRI) is the most reliable technique in brain tumor surgery. Unfortunately, it is highly expensive and time consuming and, at the moment, it is available only in few neurosurgical centers. ⋯ Integration of multiple intraoperative imaging techniques combined with rigid and elastic image fusion of preoperative MRI may reduce the risk of incorrect neuronavigation during brain tumor resection. Further studies are needed to confirm the present findings in a larger population.
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Journal of neurosurgery · May 2022
Frameless neuronavigation with computer vision and real-time tracking for bedside external ventricular drain placement: a cadaveric study.
A major obstacle to improving bedside neurosurgical procedure safety and accuracy with image guidance technologies is the lack of a rapidly deployable, real-time registration and tracking system for a moving patient. This deficiency explains the persistence of freehand placement of external ventricular drains, which has an inherent risk of inaccurate positioning, multiple passes, tract hemorrhage, and injury to adjacent brain parenchyma. Here, the authors introduce and validate a novel image registration and real-time tracking system for frameless stereotactic neuronavigation and catheter placement in the nonimmobilized patient. ⋯ This computer vision-based registration system provided real-time tracking of cadaveric heads with a recalibration time of less than one-quarter of a second with submillimetric accuracy and enabled catheter placements with millimetric accuracy. Using this approach to guide bedside ventriculostomy could reduce complications, improve safety, and be extrapolated to other frameless stereotactic applications in awake, nonimmobilized patients.
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Quadrigeminal cistern arachnoid cysts (ACs) are usually asymptomatic, may be accidental findings during radiological evaluation, and are rare (5%-10% of all intracranial ACs). We report a case of type I quadrigeminal cistern AC managed via navigation-guided cystoventriculostomy followed by endoscopic third ventriculostomy (Video 1). A 0° rod-lens endoscope was used. ⋯ Pineal region ACs and associated hydrocephalus can be successfully treated with simple, minimally invasive endoscopic procedures. Navigation assistance may not be necessary in all cases, but it allows for safe, rapid location of the fenestration site. A minimally invasive route and attention to smaller nuances of anatomy are key to safe management of these benign conditions.
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Neurovascular compression (NVC) in patients with trigeminal neuralgia (TN) can be a factor of treatment outcome, especially in microvascular decompression and stereotactic radiosurgery. No such effect has been reported in percutaneous radiofrequency rhizotomy (RF). This study aims to investigate whether NVC affects the efficacy of RF in patients with TN. ⋯ For patients with TN treated by RF, the presence or absence of NVC is not likely to affect the 1-year pain control rate.