Cent Eur Neurosurg 2004; 65(2): 57-64
DOI: 10.1055/s-2004-816237
Original Article

© Georg Thieme Verlag Stuttgart · New York

Clinical Application of Neuro-Navigation in a Series of Single Burr-Hole Procedures

Die klinische Anwendung der Neuronavigation in einer Serie von BohrlocheingriffenW. Tirakotai1 , T. Riegel1 , U. Sure1 , O. Bozinov1 , D. Hellwig1 , H. Bertalanffy1
  • 1Neurochirurgische Klinik der Philipps Universität Marburg
Further Information

Publication History

Publication Date:
30 April 2004 (online)

 

Abstract

With recent developments in computer technology and the improvement of neuroimaging, modern optical neuro-navigation systems are increasingly being used in neurosurgery. In this study, we present our experience with 51 operations using a frameless optical navigation system in a variety of single burr-hole procedures. The procedures include neuroendoscopic surgery, frameless stereotactic biopsy, cyst aspiration and catheter placement. Both the VectorVision and the VectorVision2 neuro-navigation systems (BrainLab AG, Munich, Germany) were used. The reliability and accuracy of the neuro-navigation system, postoperative complications and the clinical usefulness of image-guidance were analyzed. The navigation system worked properly in all 51 neurosurgical cases. Exact planning of the approach and determination of the ideal trajectory were possible in all cases. The mean registration error of the system, given as a computer-calculated value, was 2.1 mm (0.4-3.1 mm). Postoperative clinical evaluations and imaging were performed on every patient in order to confirm the success of the surgical procedure. All patients recovered well and without any postoperative complications. We conclude that image guidance in single burr-hole procedures provides a high degree of accuracy in lesion targeting, permits good anatomical orientation and minimizes brain trauma. The navigation system has proven to be a helpful tool since it increases the safety of single burr-hole procedures.

Zusammenfassung

Optische Navigationssysteme werden zunehmend zur Planung und Durchführung neurochirurgischer Operationen angewendet. Wir berichten in diesem Beitrag über unsere Erfahrungen mit einem optischen Neuronavigationsgerät bei insgesamt 51 Patienten. Jede der Operationen wurde über einen einfachen Bohrlochzugang durchgeführt. Die Eingriffe umfassten neuroendoskopische Operationen, rahmenlos geführte Biopsien, Zystenpunktionen und Katheteranlagen. Sowohl das VectorVision als auch das VectorVision2-System der Fa. Brainlab AG, München, wurden eingesetzt. Postoperative Komplikationen sowie Zuverlässigkeit, Genauigkeit und klinischer Nutzen der Neuronavigation wurden analysiert. Der optimale Vektor zur Zielregion konnte in allen Fällen genau bestimmt werden. Die errechnete Genauigkeit der Systeme lag bei 2,1 mm (0,4-3,1 mm). Sowohl die postoperativ durchgeführte Bildgebung als auch die klinische Untersuchung dokumentierten den Operationserfolg. Es traten keine postoperativen Komplikationen auf. Diese Studie belegt, dass die Neuronavigation ein äußerst hilfreiches Instrument ist.

Key words

Frameless stereotaxy - neuroendoscopy - neuro-navigation - single burr-hole procedures

Schlüsselwörter

Bohrloch-Trepanation - Neuroendoskopie - Neuronavigation - rahmenlose Stereotaxie

References

  • 1 Alberti O, Riegel T, Hellwig D, Bertalanffy H. Frameless navigation and endoscopy.  J Neurosurg. 2001;  95 541-543
    PubMedGoogle Scholar
  • 2 Broggi G, Dones I, Ferroli P, Franzini A, Servello D, Duca S. Image guided neuroendoscopy for third ventriculostomy.  Acta Neurochir (Wien). 2000;  142 893-899
    CrossrefPubMedGoogle Scholar
  • 3 Choudhury A R. CT measurement of the ventricular catheter length. Technical note.  Br J Neurosurg. 1993;  7 542-544
    PubMedGoogle Scholar
  • 4 Hellwig D, Riegel T, Bertalanffy H. Neuroendoscopic techniques in treatment of intracranial lesions.  Min Invas Ther & Allied Technol. 1998;  7 123-135
    PubMedGoogle Scholar
  • 5 Hellwig D, Bauer B L, Riegel T, Schmideck H H, Sweet W H. Surgical management of intracranial arachnoid, suprasellar, and Rathke’s cleft cysts. In: Schmidek HH, Sweet WH (eds). Operative Neurosurgical Techniques. 4th ed. Vol. 1. W. B. Saunders Company 2000; pp. 513-532
    Google Scholar
  • 6 Dorward N L, Alberti O, Palmer J D, Kitchen N D, Thomas D GT. Accuracy of true frameless stereotaxy: in vivo measurement and laboratory phantom studies. Technical note.  J Neurosurg. 1999;  90 160-168
    CrossrefPubMedGoogle Scholar
  • 7 Dorward N L, Alberti O, Velani B, Gerritsen F A, Harkness W FJ, Kitchen N D, Thomas D GT. Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation.  J Neurosurg. 1998;  88 656-662
    CrossrefPubMedGoogle Scholar
  • 8 Dorward N L, Alberti O, Zhao J, Dijkstra A, Buurman J, Palmer J D, Hawkes D, Thomas D GT. Interactive image-guided neuroendoscopy: development and early clinical experience.  Minim Invasive Neurosurg. 1998;  41 31-34
    PubMedGoogle Scholar
  • 9 Doward N L, Paleologos T S, Alberti O, Thomas D GT. The advantages of frameless stereotactic biopsy over frame-based biopsy.  Br J Neurosurg. 2002;  16 110-118
    CrossrefPubMedGoogle Scholar
  • 10 Gil Z, Siomin V, Beni-Adani L, Sira L B, Constantini S. Ventricular catheter placement in children with hydrocephalus and small ventricles: the use of a frameless neuronavigation system.  Child's Nerv Syst. 2002;  18 26-29
    PubMedGoogle Scholar
  • 11 Golfinos J G, Fitzpatrick B C, Smith L R, Spetzler R F. Clinical use of a frameless stereotactic arm: results of 325 cases.  J Neurosurg. 1995;  83 197-205
    CrossrefPubMedGoogle Scholar
  • 12 Grunert P, Espinosa J, Busert C, Günthner M, Filippi R, Farag S, Hopf N. Sterotactic biopsies guided by an optical navigation system: Technique and clinical experience.  Minim Invasive Neurosurg. 2002;  45 11-15
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Gumprecht H K, Widenka D C, Lumenta C B. BrainLab VectorVision neuronavigation system: technology and clinical experiences in 131 cases.  Neurosurgery. 1991;  44 97-104
    PubMedGoogle Scholar
  • 14 Hellwig D, Bauer B L, Schulte M, Gatscher S, Riegel T, Bertalanffy H. Neuroendoscopic treatment for colloid cysts of the third ventricle: The experience of a decade.  Neurosurgery. 2003;  52 525-532
    PubMedGoogle Scholar
  • 15 Hopf N J, Grunert P, Darabi K, Busert C, Bettag M. Frameless neuronavigation applied to endoscopic neurosurgery.  Minim Invasive Neurosurg. 1999;  42 187-193
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Kaus M, Steinmeier R, Sporer T, Ganslandt O, Fahlbusch R. Technical accuracy of a neuronavigation system measured with a high-precision mechanical micromanipulator.  Neurosurgery. 1997;  41 1431-1437
    CrossrefPubMedGoogle Scholar
  • 17 Keski S I, Ceviker N, Baykaner K, Alp H. Index for optimum ventricular catheter length. Technical note.  J Neurosurg. 1991;  75 152-153
    PubMedGoogle Scholar
  • 18 Kitchen N D, Lemieux L, Thomas D GT. Accuracy in frame-based and frameless stereotaxy.  Stereotact Funct Neurosurg. 1993;  61 195-206
    PubMedGoogle Scholar
  • 19 Korinth M C, Weinzierl M R, Krings T, Gilsbach J M. Occurrence and therapy of space-occupying cystic lesions after brain tumor surgery.  Zentralbl Neurochir. 2001;  62 87-92
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Kosugi Y, Watanabe E, Goto J. An articulated neurosurgical navigation system using MRI and CT images IEEE Trans.  Biomed Eng. 1998;  35 147-152
    PubMedGoogle Scholar
  • 21 Laborde G, Gilsbach J, Harders A, Klimek L, Moesges R, Krybus W. Computer assisted localizer for planning of surgery and intra-operative orientation.  Acta Neurochir (Wien). 1992;  119 166-170
    CrossrefPubMedGoogle Scholar
  • 22 Maciunas R J, Galloway R L, Latimer J, Cobb C, Zaccharias E, Moore A, Mandava V R. An independent application accuracy evaluation of stereotactic frame systems.  Stereotact Funct Neurosurg. 1992;  58 103-107
    PubMedGoogle Scholar
  • 23 McCallum J. Combined frameless stereotaxy and neuroendoscopy in placement of intracranial shunt catheters.  Pediatr Neurosurg. 1997;  26 127-129
    PubMedGoogle Scholar
  • 24 Muacevic A, Muller A. Imaged-guided endoscopic ventriculostomy with a new frameless armless neuronavigation system.  Comput Aided Surg. 1999;  4 87-92
    CrossrefPubMedGoogle Scholar
  • 25 Riegel T, Alberti O, Hellwig D, Bertalanffy H. Operative management of third ventriculostomy in cases of thickened, non-translucent third ventricular floor: Technical note.  Minim Invasive Neurosurg. 2001;  44 65-69
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Riegel T, Hellwig D, Bauer B L, Mennel H D. Endoscopic anatomy of the third ventricle.  Acta Neurochir Suppl (Wien). 1994;  61 54-56
    PubMedGoogle Scholar
  • 27 Rhoten R L, Luciano M G, Barnett G H. Computer-assisted endoscopy for neurosurgical procedures: technical note.  Neurosurgery. 1997;  40 632-638
    PubMedGoogle Scholar
  • 28 Roberts D W, Hartov A, Kennedy F E, Miga M I, Paulsen K D. Intraoperative brain shift and deformation: A quantitative analysis of cortical displacement in 28 cases.  Neurosurgery. 1998;  43 749-758
    CrossrefPubMedGoogle Scholar
  • 29 Roberts D W, Strohbehn J W, Hatch J F, Murray W, Kettenberger H. A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope.  J Neurosurg. 1986;  65 545-549
    PubMedGoogle Scholar
  • 30 Rohde V, Reinges M H, Krombach G A, Gilsbach J M. The combined 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
    CrossrefPubMedGoogle Scholar
  • 31 Savitz M H, Bobroff L M. Low incidence of delayed intracerebral hemorrhage secondary to ventriculoperitoneal shunt insertion.  J Neurosurg. 1999;  91 32-34
    CrossrefPubMedGoogle Scholar
  • 32 Schroeder H W, Wagner W, Tschiltschke W, Gaab M R. Frameless neuronavigation in intracranial endoscopic neurosurgery.  J Neurosurg. 2001;  94 72-79
    CrossrefPubMedGoogle Scholar
  • 33 Spetzger U, Laborde G, Gilsbach J M. Frameless neuronavigation in modern neurosurgery.  Minim Invasive Neurosurg. 1995;  38 163-166
    Google Scholar
  • 34 Steinmeier R, Rachinger J, Kaus M, Ganslandt O, Huk W, Fahlbusch R. Factors influencing the application accuracy of neuronavigation systems.  Stereotact Funct Neurosurg. 2000;  75 188-202
    CrossrefPubMedGoogle Scholar
  • 35 Sure U, Hellwig D, Bertalanffy H. Incorrect vector after calibration of surgical instrument for image-guidance: the problem and the solution: technical note.  Minim Invasive Neurosurg. 2001;  44 88-91
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Wagner W, Gaab M R, Schroeder H W, Piek J, Niendorf W R. Neuronavigation in the central area: Impact on different surgical steps related to the location of pathologic processes.  Zentralbl Neurochir. 2000;  61 183-193
    PubMedGoogle Scholar
  • 37 Wiesmann M, Mayer T E. Intracranial bleeding rates associated with two methods of external ventricular drainage.  J Clin Neurosci. 2001;  8 126-128
    CrossrefPubMedGoogle Scholar
  • 38 Yamamoto M, Jimbo M, Hara M, Saito I, Mori K. Gamma knife radiosurgery for arteriovenous malformations: long-term follow-up results focusing on complications occurring more than 5 years after irradiation.  Neurosurgery. 1996;  38 906-914
    CrossrefPubMedGoogle Scholar

M. D., M. Sc. Wuttipong Tirakotai

Neurochirurgische Klinik der Philipps-Universität Marburg

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35033 Marburg

Germany

Phone: +49/64 21-2 86 64 47

Fax: +49/64 21-2 86 64 15

Email: riegel@med.uni-marburg.de

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