Articles: neuronavigation.
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Neurosurgical review · Jan 2013
Comparative StudyComparison of navigated transcranial magnetic stimulation and functional magnetic resonance imaging for preoperative mapping in rolandic tumor surgery.
Navigated transcranial magnetic stimulation (nTMS) is a novel tool for preoperative functional mapping. It detects eloquent cortical areas directly, comparable to intraoperative direct cortical stimulation (DCS). The aim of this study was to evaluate the advantage of nTMS in comparison with functional magnetic resonance imaging (fMRI) in the clinical setting. ⋯ Using nTMS, a preoperative localization of the central sulcus was possible in all patients. Verification of nTMS motor cortex localization with DCS was achieved in all cases. The fMRI localization of the hand area proved to be postcentral in one case. nTMS has fewer restrictions for preoperative functional mapping than fMRI and requires only a limited level of compliance. nTMS scores higher on the accuracy scale than fMRI. nTMS represents a highly valuable supplement for the preoperative functional planning in the clinical routine.
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Cranial surgical navigation is most commonly performed by registration with fiducial markers, optic tracking, and intermittent pointer-based application. ⋯ Continuous instrument navigation is the prerequisite for seamless integration of navigation systems into the neurosurgical operating workflow. Our data confirm that the application of preoperative imaging, surface-merge registration, and continuous electromagnetic tip-tracked instrument navigation may provide such integration without a significant reduction in accuracy compared with standard navigation.
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Journal of neurosurgery · Jan 2013
Case ReportsNavigated transcranial magnetic stimulation for preoperative language mapping in a patient with a left frontoopercular glioblastoma.
Up to now, navigated transcranial magnetic stimulation (nTMS) has been used for motor mapping in the vicinity of rolandic brain lesions. Recently, nTMS has also been suggested to be useful in mapping human language areas. The authors describe the case of a left-handed patient with a left-side glioblastoma within the opercular inferior frontal gyrus who presented with severe motor aphasia. ⋯ Navigated TMS, however, showed a significantly higher rate of induced speech arrests for the left than for the right. Left-side direct cortical stimulation induced clear speech arrests during awake surgery. This case suggests that nTMS may be useful for preoperative speech mapping in tumors affecting the anatomy, vasculature, and brain oxygen levels and therefore impairing fMRI reliability.
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Case Reports Clinical Trial
Mono-stereo-autostereo: the evolution of 3-dimensional neurosurgical planning.
In the past decade, surgery planning has changed significantly. The main reason is the improvements in computer graphical rendering power and display technology, which turned the plain graphics of the mid-1990s into interactive stereoscopic objects. ⋯ Improvement of display and interaction techniques adds to the realism of the planning process and enables precise structural understanding preoperatively. This minimizes intraoperative guesswork and exploratory dissection. Autostereoscopic display techniques will further increase the value and acceptance of 3-dimensional planning and intraoperative navigation.
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Deep brain stimulation (DBS) candidates with neurologic diseases such as unruptured aneurysm present additional challenges to neurosurgeons when craniotomy must precede DBS surgery. Such craniotomy may potentially overlap with intended burr hole sites for the later insertion of DBS electrodes, and the skin incision for craniotomy may lie very close to or intersect with that for the burr holes. We report here a case of forehead craniotomy prior to DBS surgery in which we employed a neuronavigation system to simulate locations for the craniotomy and burr holes. ⋯ Simulation of the locations of craniotomy and burr holes using a neuronavigation system proved valuable in the present case of frontal craniotomy before DBS surgery.