Simultaneous skull tumor resection and prosthetic reconstruction are possible when a virtual preoperative tumor resection is performed, and a corresponding customized prosthesis subsequently is manufactured and used.
The mirroring technique represents an accurate method of outlining the contralateral normal anatomy onto the pathological side based on navigation guidance.
Stereotactic radiosurgery treatment principles and irradiation techniques have shown little evolution since its introduction in 1968. Conversely, technology progress linked to computers has produced a major impact on the methods used for treatment planning and dose delivery. In order to fully comprehend modern radiosurgery approaches, one has to acquire good insight of the underlying technology, specifically computer software. In this chapter, we describe the evolution from X-ray films to high-resolution digital imaging, the shift from simple trigonometric calculation to highly complex algorithms and new perspectives in patient follow-up. If these changes open new prospects, they also add complexity, which leads to new pitfalls and limits of the stereotactic radiosurgery method.
The superficial temporal artery (STA) is frequently used as donor vessel in extracranial to intracranial bypass surgery. Current techniques typically rely on a Doppler vascular probe to identify the STA trajectory prior to the skin incision; however, this step can be time consuming and difficult when the arterial course is tortuous. We tested an alternative neuronavigation-based technique for locating the STA. In this method, preoperative magnetic resonance angiography (MRA) or computed tomography angiography (CTA) was used to determine STA outlines that were then projected and traced onto the skin. The neuronavigation-based technique was applied to eight STA dissections. The accuracy of this method was evaluated by comparing the navigation-based STA course with the doppler-based one and the actual STA course intraoperatively. STA trajectory was determined before surgery by using three imaging techniques: CTA (3 cases), three-dimensional (3D) contrast-enhanced T1-weighted MRA (4 cases), and/or 3D time-of-flight MRA (5 cases). In all cases, the neuronavigation-based STA position was confirmed with the Doppler vascular probe before skin incision and corresponded to the actual vessel position intraoperatively. As long as the skin is not mobilized during preoperative image acquisition and surgery, this neuronavigation-based approach is a valid method to identify STA course. During the preoperative planning process, the STA trajectory should be analyzed from its origin at the level of the foramen spinosum to avoid mistaking nearby venous structures as the STA.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.