Frameless neuronavigation in intracranial endoscopic neurosurgery

Schroeder, Henry W. S.; Wagner, Wolfgang; Tschiltschke, W.; Gaab, M. R.

doi:10.3171/jns.2001.94.1.0072

Cited by 119 publications

(56 citation statements)

References 55 publications

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“…A couple of experienced groups for endoscopic surgery subsequently suggested the advantages of navigational guidance for endoscopic cannulation into the ventricle in patients without hydrocephalus 4,10,20) . Even though the conventional stereotactic needle biopsy is a valid alternative for tumor sampling in these situation, the endoscopic technique does offer several potential advantages, including ventriculoscopic inspection for any metastatic potential, CSF sampling for staging, direct visualization allowing avoidance of choroid plexus or vascular tributaries, and the ability to perform simultaneous procedures if indicated (endoscopic third ventriculostomy, septostomy, or tumor cyst decompression).…”

Section: Discussionmentioning

confidence: 99%

Transventricular Biopsy of Brain Tumor without Hydrocephalus Using Neuroendoscopy with Navigation

Song

Kong

Seol

et al. 2010

J Korean Neurosurg Soc

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Objective : It is usually difficult to perform the neuroendoscopic procedure in patients without hydrocephalus due to difficulties with ventricular cannulation. The purpose of this study was to find out the value of navigation guided neuroendoscopic biopsy in patients with peri-or intraventricular tumors without hydrocephalus. Methods : Six patients with brain tumors without hydrocephalus underwent navigation-guided neuroendoscopic biopsy. The procedure was indicated for verification of the histological diagnosis of the neoplasm, which was planned to be treated by chemotherapy and/or radiotherapy as the first line treatment, or establishment of the pathological diagnosis for further choice of the most appropriate treatment strategy. Results : Under the guidance of navigation, targeted lesion was successfully approached in all patients. Navigational tracking was especially helpful in entering small ventricles and in approaching the third ventricle through narrow foramen Monro. The histopathologic diagnosis was established in all of 6 patients : 2 germinomas, 2 astrocytomas, 1 dysembryoplastic neuroepithelial tumor and 1 pineocytoma. The tumor biopsy sites were pineal gland (n = 2), suprasellar area (n = 2), subcallosal area (n = 1) and thalamus (n = 1). There were no operative complications related to the endoscopic procedure. Conclusion : Endoscopic biopsy or resection of peri-or intraventricular tumors in patients without hydrocephalus is feasible. Image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of ventriculomegaly in patients with brain tumor may not be served as a contraindication to endoscopic tumor biopsy.

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Section: Discussionmentioning

confidence: 99%

Transventricular Biopsy of Brain Tumor without Hydrocephalus Using Neuroendoscopy with Navigation

Song

Kong

Seol

et al. 2010

J Korean Neurosurg Soc

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“…Despite the well-documented application of nonrobotic stereotactic approaches in neuroendoscopy, 46,53,55 we opted for the robotic assistance to validate this technique in easier cases, (e.g., third ventriculostomy for obstructive hydrocephalus), especially at the beginning of our experience. More recently, we progressively changed the indications to more complex cases.…”

Section: Endoscopy-guided Proceduresmentioning

confidence: 99%

Robot-assisted procedures in pediatric neurosurgery

Benedictis¹,

Trezza

Carai³

et al. 2017

Neurosurgical Focus

144

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OBJECTIVEDuring the last 3 decades, robotic technology has rapidly spread across several surgical fields due to the continuous evolution of its versatility, stability, dexterity, and haptic properties. Neurosurgery pioneered the development of robotics, with the aim of improving the quality of several procedures requiring a high degree of accuracy and safety. Moreover, robot-guided approaches are of special interest in pediatric patients, who often have altered anatomy and challenging relationships between the diseased and eloquent structures. Nevertheless, the use of robots has been rarely reported in children. In this work, the authors describe their experience using the ROSA device (Robotized Stereotactic Assistant) in the neurosurgical management of a pediatric population.METHODSBetween 2011 and 2016, 116 children underwent ROSA-assisted procedures for a variety of diseases (epilepsy, brain tumors, intra- or extraventricular and tumor cysts, obstructive hydrocephalus, and movement and behavioral disorders). Each patient received accurate preoperative planning of optimal trajectories, intraoperative frameless registration, surgical treatment using specific instruments held by the robotic arm, and postoperative CT or MR imaging.RESULTSThe authors performed 128 consecutive surgeries, including implantation of 386 electrodes for stereo-electroencephalography (36 procedures), neuroendoscopy (42 procedures), stereotactic biopsy (26 procedures), pallidotomy (12 procedures), shunt placement (6 procedures), deep brain stimulation procedures (3 procedures), and stereotactic cyst aspiration (3 procedures). For each procedure, the authors analyzed and discussed accuracy, timing, and complications.CONCLUSIONSTo the best their knowledge, the authors present the largest reported series of pediatric neurosurgical cases assisted by robotic support. The ROSA system provided improved safety and feasibility of minimally invasive approaches, thus optimizing the surgical result, while minimizing postoperative morbidity.

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“…By this method of using stereotactic navigation in initial cannulation and direct visualization of the tract to the ventricle by endoscope, we could eliminate the freehand procedures, which may increase the possibility of inaccurate cannulation or misguided introduction of the endoscope, as previously described. 10,11,27 A flexible endoscope has excellent maneuverability with its tip flexion in any direction with rotation of the shaft, allowing an accurate tracing of the tract to the ventricles. Such maneuverability could be more advantageous than that of a rigid endoscope in introducing the endoscope down the tract.…”

Section: Discussionmentioning

confidence: 99%

Flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles

Ogiwara¹,

Morota²

2014

PED

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Object Endoscopic surgery is generally withheld in patients with small ventricles due to difficulties in ventricular cannulation and intraventricular manipulation. The effectiveness of flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles was evaluated. Methods Forty-five patients who underwent endoscopic surgery with a flexible endoscope for intraventricular brain tumors were divided into small-ventricle and ventriculomegaly groups according to the frontal and occipital horn ratio (FOR). Retrospective review of these cases was performed and achievement of surgical goals and morbidity were assessed. Results Among the 45 patients, there were 14 with small ventricles and 31 with ventriculomegaly. In the smallventricle group, targeted tumors were located in the suprasellar region in 12 patients and in the pineal region in 2. In the ventriculomegaly group, tumors were located in the pineal region in 15 patients, in the suprasellar region in 9, in the lateral ventricle in 4, in the midbrain in 2, and in the fourth ventricle in 1. In the small-ventricle group, ventricular cannulation was successful and the surgical goals were accomplished in all patients. In ventriculomegaly group, sampling of the tumor was not diagnostic due to intraoperative hemorrhage in 1 patient. There were no significant differences in the rate of achieving the surgical goals or the morbidity between the 2 groups. Conclusions Endoscopic surgery using a flexible endoscope is useful for management of intraventricular brain tumors in patients with small ventricles. A flexible endoscope allows excellent maneuverability in introducing the device into the lateral ventricle and manipulating through small ventricles.

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Frameless neuronavigation in intracranial endoscopic neurosurgery

Abstract: Frameless neuronavigation has proven to be accurate, reliable, and extremely useful in selected intracranial neuroendoscopic procedures. Image-guided neuroendoscopy improved the accuracy of the endoscopic approach and minimized brain trauma.

Cited by 119 publications

References 55 publications

Transventricular Biopsy of Brain Tumor without Hydrocephalus Using Neuroendoscopy with Navigation

Transventricular Biopsy of Brain Tumor without Hydrocephalus Using Neuroendoscopy with Navigation

Robot-assisted procedures in pediatric neurosurgery

Flexible endoscopy for management of intraventricular brain tumors in patients with small ventricles

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