Efficacy of a Navigation System in Neuroendoscopic Surgery

Abstract

Objective: Neuroendoscopy is playing a greater role in the diagnosis and treatment of several types of lesions, especially in the ventricular system. However, surgical planning and intraoperative orientation during endoscopic surgery are sometimes difficult. The efficacy of a neurosurgical navigation system using three-dimensional computer graphics of magnetic resonance (MR) images in neuroendoscopic surgery was evaluated in this study. Methods: We have developed a navigational endoscopic system designed to monitor the tip and direction of the endoscope, with the mirror marker of the navigation connected to a rigid endoscope. Eight patients, 3 cases of aqueductal stenting for isolated fourth ventricle, 3 cases of cystostomy for ependymal cyst, 1 case of septostomy for isolated lateral ventricle, and 1 case of ventricular tap in narrow ventricles, underwent endoscopic surgery using the present system. Results: All patients underwent successful procedures with good outcomes. The present system was very useful in the cases of an accurate ventricular tap in narrow ventricles, identification of anatomic structures, and determining the appropriate route to the target point. Conclusions: This navigational endoscopic system improved the safety and accuracy of neuroendoscopic surgery.

Key words

Navigation - neuroendoscopy - efficacy

References

• 1 Abe M, Udono H, Tabuchi K, Uchino A. Transsphenoidal surgery assisted by navigation system (in Japanese).  No Shinkei Geka. 2001;  29 31-38
• 2 Balmer B, Bernays R L, Kollias S S, Yonekawa Y. Interventional MR-guided neuroendoscopy: a new therapeutic option for children.  J Pediatr Surg. 2002;  37 668-672
• 3 Grunert P, Hopf N, Perneczky A. Frame-based and frameless endoscopic procedures in the third ventricle.  Stereotact Funct Neurosurg. 1997;  68 80-89
• 4 Gumprecht H, Trost H A, Lumenta C B. Neuroendoscopy combined with frameless neuronavigation.  Br J Neurosurg. 2000;  14 129-131
• 5 Hamada H, Hayashi N, Endo S, Kurimoto M, Hirashima Y, Takaku A. Endoscopic aqueductal plasty via the fourth ventricle through the cerebellar hemisphere under navigating system guidance - Technical note.  Neurol Med Chir (Tokyo). 1999;  39 950-954
• 6 Hayashi N, Endo S, Ikeda H, Takaku A. Neuronavigation using an articulated arm with a bayonet probe on a computer graphic composite of magnetic resonance and computerized tomography images.  Minim Invas Neurosurg. 1998;  41 144-148
• 7 Hayashi N, Kurimoto M, Hirashima Y, Ikeda H, Shibata T, Tomita T, Endo S. Efficacy of navigation in skull base surgery using composite computer graphics of magnetic resonance and computed tomography images.  Neurol Med Chir (Tokyo). 2001;  41 335-359
• 8 Kawamata T, Iseki H, Shibasaki T, Hori T. Endoscopic augmented reality navigation system for endonasal transsphenoidal surgery to treat pituitary tumors: technical note.  Neurosurgery. 2002;  50 1393-1397
• 9 Nagata T, Saito K, Yoshida J. Treatment of a sphenoid sinus mucocele using an endoscope combined with a navigating system: a case report.  J Clin Neuroscience. 2001;  8 456-460
• 10 Reinacher P C, Velthoven V van. Intraoperative ultrasound imaging: practical applicability as a real-time navigation system.  Acta Neurochir Suppl. 2003;  85 89-93
• 11 Riegel T, Alberti O, Hellwig D, Bertalanffy H. Operative management of third ventriculostomy in cases of thickened, non-translucent third ventricle floor: technical note.  Minim Invas Neurosurg. 2001;  44 65-69
• 12 Rhode V, Reinges M H, Krombach G A, Gilsbach J M. The combination use of image-guided frameless stereotaxy and neuroendoscopy for the surgical management of occlusive hydrocephalus and intracranial cysts.  Br J Neurosurg. 1998;  12 531-538
• 13 Rhoten R L, Luciano M G, Barnett G H. Computer-assisted endoscopy for neurosurgical procedures: technical note.  Neurosurgery. 1997;  40 632-638
• 14 Volpe J J. Neurology of the newborn. 4^th edn. Philadelphia, PA: Saunders 2001: 428-493