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Neuronavigated surgery of intracranial cavernomas--enthusiasm for high technologies or a gold standard?
Yavor P Enchev1, Rumen V Popov, Kiril V Romansky
1Clinic of Neurosurgery, St. I. Rilsky University Hospital, Medical University, Sofia, Bulgaria. dr.y.enchev@gmail.com
Aim:
The aim of this study was to investigate the effect of neuronavigation on the following parameters: "skin incision", "craniotomy", "intraoperative anatomical orientation", "dissection guiding", "localization of the pathological formation", "assessment of the degree of resection" and "duration of surgical procedure" in resections of intracranial cavernomas and to specify the indications for neuronavigation in their surgical treatment.
Patients And Methods:
The present prospective study included 20 patients with intracranial cavernomas who underwent neuronavigated surgery between March 2003 and December 2005 at the Clinic of Neurosurgery of the "St. I. Rilsky" University Hospital, Medical University, Sofia. The female/male ratio in the series was 9/11 (45%-55%). The patients' mean age was 27.96 +/- 11.61 years (age range 1.2 to 44 years). The patients were examined and followed up in a standard manner.
Results:
Cavernous malformations were totally removed in 19 patients. One patient with thalamic cavernoma underwent navigated endoscopic biopsy. There was no morbidity or mortality associated with the method. Neuronavigation allowed precise localization and individual design of the skin incision and craniotomy. Neuronavigated intraoperative anatomical orientation, dissection guiding, localization of the pathological formation, and assessment of degree of resection were evaluated as markedly useful. They resulted in excellent surgery results and reduced operation time in comparison with the conventional surgery.
Conclusion:
In intracranial cavernomas frameless stereotaxy provides the surgeon with useful feedback in the preoperative anatomical orientation, the planning and simulation of surgical approach, the intraoperative navigation, in avoiding vital neurovascular structures, in the assessment of the degree of resection and the identification of possible residual parts. That is why cavernous malformations are among the most common indications for cranial neuronavigation.
