Image-Guided Transsylvian, Transinsular Approach for Insular Cavernous Angiomas

Tirakotai, Wuttipong; Sure, Ulrich; Benes, Ludwig; Krischek, Boris; Bien, Siegfried; Bertalanffy, Helmut

doi:10.1227/01.neu.0000279234.81320.eb

Cited by 29 publications

(19 citation statements)

References 50 publications

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“…As aquisições por ressonância magnética em T1 e T2 complementam-se na localização. Neuronavegação ou estereotaxia são necessárias na maioria das vezes, principalmente em lesões menores 26 .…”

Section: Relato Do Casounclassified

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Cavernoma gigante de ínsula esquerda operado por via subfrontal: Relato de caso

Stávale¹

2008

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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IntroduçãoCavernomas dos núcleos profundos e suas conexões constituem 7% a 20% dos cavernomas encefálicos 1,3,22 . Parece haver preponderância no sexo feminino e o diagnóstico é feito em todas as idades 1,3,22 , mas a maioria na terceira e quarta décadas de vida 3,10 .Pela sua localização, provocam sintomas mesmo com pequenos sangramentos, o que pode conferir uma idéia estatística de que eles apresentam sangramentos mais freqüentes do que as lesões corticais e subcorticais 3,18 . O risco de hemorragia dessas lesões varia entre 0,7% e 5% por ano e, se houver historia prévia de hemorragia, relatam-se taxas de sangramento atual entre 4,55% e 30% 23 . Podem aumentar de tamanho e ser múltiplas em 2,5% dos pacientes 3,4,7,18,19,20 . Relato do casoPRG, sexo feminino, 26 anos, odontologista. Apresentou cefaléia persistente e mínimas alterações motoras subjetivas na mão direita. O exame por ressonância magnética (RM) revelou volumoso cavernoma ocupando o compartimento anterior da ínsula esquerda, acima da substância perfurada anterior (Figuras 1, 2 e 3). A angiografia cerebral por cateterismo revelou que as artérias perfurantes estavam deslocadas posteroinferiormente em relação à massa. Uma craniotomia frontotemporal com maior expansão frontal foi realizada e a cisterna silviana foi aberta, expondo-se completamente a superfície inferior do lobo frontal. Uma corticortomia nos giros orbitários, lateral ao trígono olfatório e anterior à substância perfurada anterior, permitiu a remoção da lesão sem seqüelas. A craniotomia permitiu ângulos visuais anteriores e laterais da cavidade cirúrgica, facilitando a ressecção.

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Section: Relato Do Casounclassified

“…Lesões laterais junto aos núcleos basais podem ser operadas por via transilviana 14,26 . É importante preservar as artérias lenticuloestriadas e conhecer exatamente a relação da lesão com os compartimentos da cápsula interna.…”

Section: Relato Do Casounclassified

Cavernoma gigante de ínsula esquerda operado por via subfrontal: Relato de caso

Stávale¹

2008

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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“…1,12,13) In addition to the intraoperative use of the navigation system, the preoperative planning technique of multimodal image fusion of three-dimensional (3D) reconstruction of computed tomography (CT) and magnetic resonance (MR) imaging allows neurosurgeons to perform more accurate and less invasive operations. 4,5) However, the practical application of 3D preoperative planning images has not been compared to intraoperative views.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Surgical Approach Planning for Metastatic Pituitary Stalk Tumor Using Multimodal Fusion Imaging in a Neuronavigation System -Case Report-

Yamada

Masahira

Ikawa

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 72-year-old woman presented with a metastatic brain tumor around the pituitary stalk compressing the chiasm anteriorly and upward. After tumor resection by a left pterional approach failed, a threedimensional (3D) image of the area of interest was reconstructed using the Vecter Vision 2 navigation system and iPlan Cranial planning software version 2.5. Preoperative 3D computed tomography and magnetic resonance imaging data were fused to demonstrate the anatomical relationship between vessels, nerves, and tumor. Clearer demonstration of the optic nerves utilized thin slice axial and sagittal views along the nerves. The 3D reconstructed image demonstrated the spatial relationship of the tumor and surrounding tissue, and suggested the necessity of a right orbitozygomatic approach to create adequate working space for tumor resection. Second surgery according to this preoperative planning was successful. High quality multimodal fusion images in a navigation system has distinct advantages in preoperative assessment of essential structural relationships allowing adequate exposure of certain lesions and surrounding structures in individual patients by defining specific surgical approaches.

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“…Image-guided neuronavigation systems have become an integral part of the neurosurgical operating room (OR) [1][2][3][4][5] . Although stereotactic frame systems are still used, frameless image-guided surgery is increasingly preferred due to its ease of use in the OR, the decrease in OR time compared to frame-based systems, unimpeded access to the surgical area and a high degree of accuracy [5][6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Accuracy of a Compact Intraoperative MRI System

Salas

Brimacombe²,

Schulder

2006

Stereotact Funct Neurosurg

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Objective: To analyze the stereotactic accuracy of the PoleStar N-20, a compact intraoperative magnetic resonance imaging (iMRI) system, based on a 0.15-Tesla (T) magnet. Methods: An MRI-compatible phantom was scanned after being positioned in both the center of the magnetic field (COF) and the periphery of the field (POF) of the PoleStar N-20 magnet. Scans were acquired at various slice thicknesses in 3 sequences: T₁ weighted, T₂ weighted and Esteady (reversed fast imaging with steady-state precession, also known as ‘PSIF’). The distance between the actual location of the probe tip in space and the location of the target on the image was measured on the axial, coronal, and sagittal planes for 9 points on each image. Each measurement was repeated 3 times. We also compared the structural features of the PoleStar N-20 to those of its predecessor. Results: T₁-weighted scans yielded the most accurate measurements. There was no statistically significant difference between scans acquired at thicknesses of 2, 3, 4 and 8 mm; all were accurate for clinical purposes. Comparison of COF with POF measurements using T₁-weighted scans did not demonstrate a statistically significant difference in accuracy. Conclusions: The PoleStar N-20 0.15-T iMRI system provides surgical navigation that is at least as accurate as the first generation model of this system, which employed a 0.12-T magnet. Further analysis of stereotactic accuracy on clinical cases using the PoleStar N-20 is needed to confirm that these results will bear out in surgical reality.

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Image-Guided Transsylvian, Transinsular Approach for Insular Cavernous Angiomas

Abstract: Image guidance during surgery for insular cavernomas provides high accuracy for lesion targeting and permits excellent anatomic orientation. Accordingly, safe exposure can be obtained because of a tailored dissection of the sylvian fissure and minimal insular corticotomy.

Cited by 29 publications

References 50 publications

Cavernoma gigante de ínsula esquerda operado por via subfrontal: Relato de caso

Cavernoma gigante de ínsula esquerda operado por via subfrontal: Relato de caso

Preoperative Surgical Approach Planning for Metastatic Pituitary Stalk Tumor Using Multimodal Fusion Imaging in a Neuronavigation System -Case Report-

Stereotactic Accuracy of a Compact Intraoperative MRI System

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