Articles: neuronavigation.
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The purpose of this study is to compare the surgical and imaging outcome in children who underwent brain tumour surgery with intention of complete tumour resection, prior to and following the start of intra-operative MRI (ioMRI) service. ⋯ Following the advent of ioMRI at our institution, the need for repeat resection within 6 months has been prevented in cases where ioMRI revealed unequivocal evidence of residual tumour.
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Acta neurochirurgica · Oct 2013
The preoperative use of navigated transcranial magnetic stimulation facilitates early resection of suspected low-grade gliomas in the motor cortex.
Resection is recommended for low-grade gliomas, but often it is not performed if the tumor is suspected of invading the primary motor cortex. The study aim is to assess what influence preoperative navigated transcranial magnetic stimulation (nTMS) has on the treatment strategy and clinical outcome for suspected low-grade gliomas in presumed motor eloquent location. ⋯ nTMS provides accurate motor mapping results also in infiltrative gliomas and enables more frequent and more extensive surgical resection of non-enhancing gliomas in or near the primary motor cortex. The substantial differences observed here in neurological and oncological outcomes suggest that further comparative research is warranted.
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Preoperative brain mapping is vital to improve the outcome of patients with tumors located in eloquent areas. While functional magnetic resonance imaging (fMRI) remains the most commonly used preoperative mapping technique, navigated transcranial magnetic stimulation (nTMS) has recently been proposed as a new preoperative method for the clinical and surgical management of such patients. This study aims at evaluating the impact of nTMS as a routine examination and its ultimate contribution to patient outcome. ⋯ Each patient underwent preoperative cortical brain mapping via both fMRI and nTMS; then, we assessed the reliability of both methods by comparing them with intraoperative mapping by direct cortical stimulation (DCS). This study suggests that nTMS was more accurate than fMRI in detecting the true cortical motor area when compared with DCS data, with a mean of deviation ± confidence interval (CI) of 8.47 ± 4.6 mm between nTMS and DCS and of 12.9 ± 5.7 mm between fMRI and DCS (p < 0.05). The results indicated that within the limits of our statistical sample, nTMS was found to be a useful, reliable, and non-invasive option for preoperative planning as well as for the identification of the motor strip; in addition, it usually has short processing times and is very well tolerated by patients, thereby increasing their compliance and possibly improving surgical outcome.
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Case Reports
The mirroring technique: a navigation-based method for reconstructing a symmetrical orbit and cranial vault.
The reconstruction of orbital structures and the cranial vault curvature can be challenging after trauma or wide resections for tumors. Sophisticated methods have been developed recently, but these are resource- and time-consuming. ⋯ The mirroring technique represents an accurate method of outlining the contralateral normal anatomy onto the pathological side based on navigation guidance.
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Surgery of lesions of the petrous apex involving the inframeatal/infralabyrinthine area is challenging and related to a high risk of complications. Various extensive skull-base approaches have been used. ⋯ Our initial experience with the retrosigmoid inframeatal approach showed that it provides sufficient access to the area and offers the possibility of complete tumor removal. It allows for hearing and facial nerve functional preservation. The approach is safe and related to a very low complication rate.