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Computer assisted brain surgery for small lesions in the central sensorimotor region
H F Reinhardt1, M Trippel, B Westermann
1Neurosurgical University Clinic, Kantonsspital Basel, Switzerland.
Abstract:
The capacity of a new optical navigation device is demonstrated by six microsurgical procedures for small subcortical lesions within the central sensorimotor strip. This small series is aimed at less invasive resection in this functionally critical region, independently of primary diagnosis and outcome. Guided by high resolution CT imaging data five brain tumours and one cavernous angioma was selectively located and most sparingly removed without additional sensorimotor deficit. In two cases improvement of a pre-operative paresis was observed immediately after surgery. Thanks to light-weight freehand pointing instruments and a ranging accuracy of +/- 1 mm, damage to functionally important brain areas and vessels was avoided by using uncommonly oblique, e.g., transsulcal ways of access which would hardly have been possible even with guidance by conventional stereotaxy. The demanding systematic cortical stimulation of the precentral gyrus applied in three cases was only sensitive in infiltrating tumours-e.g., low grade astrocytomas-where for want of adjuvant therapy it was essential to proceed to the extreme limits of resection. In general, precise anatomical localisation by computer aided surgery (CAS) is sufficient in small central lesions which guarantees minimally invasive surgery. The potential of this new, soon commercially available optical navigation system in (neuro) surgery, quality control and teaching is discussed.
Insights
A new optical navigation system enables minimally invasive surgery for brain lesions. This technology precisely locates and removes tumors and angiomas, avoiding damage to critical brain areas and improving patient outcomes.
Area of Science:
- Neurosurgery
- Medical Technology
- Image-Guided Therapy
Background:
- Minimally invasive resection in the central sensorimotor strip is challenging due to the critical function of this brain region.
- Conventional stereotaxy may have limitations in guiding surgical access to small, deep-seated lesions.
Purpose of the Study:
- To demonstrate the efficacy of a novel optical navigation device in microsurgical procedures.
- To assess the feasibility of less invasive resection for subcortical lesions in the sensorimotor strip.
Main Methods:
- Six microsurgical procedures were performed using a new optical navigation system guided by high-resolution CT imaging.
- The system utilized light-weight, freehand pointing instruments with +/- 1 mm accuracy for precise lesion localization and removal.
- Surgical access involved oblique, transsulcal approaches to minimize damage to surrounding brain tissue and vessels.
Main Results:
- Five brain tumors and one cavernous angioma were successfully located and resected with minimal invasiveness.
- No additional sensorimotor deficits were observed post-surgery.
- Two patients experienced immediate improvement in pre-operative paresis.
- Cortical stimulation in three cases identified infiltrating tumors, enabling maximal resection.
Conclusions:
- Computer-aided surgery (CAS) with optical navigation provides precise anatomical localization for small central lesions, facilitating minimally invasive neurosurgery.
- The demonstrated optical navigation system shows significant potential for improving surgical precision, quality control, and training in neurosurgery.