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Clinical benefit of image guidance in neurosurgery
International Congress Series 1230 (2001) 99 – 101
Clinical benefit of image guidance in neurosurgery Kurt Holl *, Willibald Wies, Gabriele Wurm ¨ . Landesnervenklinik Wagner Jauregg, Wagner Jauregg Weg 15, Neurosurgical Department, O.O 4021 Linz, Austria
Keywords: Neurosurgery; Neuronavigation; Computer-assisted surgery; Benefit
1. Purpose Neuronavigational devices with three-dimensional image-reconstruction allow accurate preoperative planning and intra-operative localization of regions of interest and risk zones. Therefore, image-guidance nowadays is considered to have its justification in or adjacent to eloquent areas of the brain. This especially holds true for elective surgery in areas of complex anatomy. On the other hand, little is known about the clinical benefit for the patient. In literature, there is a lack of follow-up studies that concern duration of the surgical procedure, complication rate, and postoperative course of the patients with neurological outcome or survival time. In order to fully assess the advantages of image guided techniques over conventional planning and surgery in selected cases, detailed evaluation of the imageguided procedures of our neurosurgical department was carried out.
2. Patients and methods In our department, we use the optically guided systems SNS by Zeiss and Stealth Station by Medtronic. Over a 43-month period (April 1997 to December 2000), 346 image-guided procedures have been performed in our neurosurgical department. There were 316 cranial (291 by ZEISS and 25 by Stealth Station) and 29 spinal (all by Stealth Station) procedures. Image-guidance was based on CT-imaging in 31 cases, on MRimaging in 281 cases, and on CT-MR-fusion in 5 cases. *
Corresponding author. Tel.: +43-732-6921; fax: +43-732-6921-2811. E-mail address: mailto:[email protected] (K. Holl).
0531-5131/01/$ – see front matter D 2001 Elsevier Science B.V. All rights reserved. PII: S 0 5 3 1 - 5 1 3 1 ( 0 1 ) 0 0 0 2 3 - 1
100
K. Holl et al. / International Congress Series 1230 (2001) 99–101
Table 1 Image-guided operative procedures 89 49 35 27 5 5 72 35 29
Intracerebral glioma Cranial metastase Meningeoma Intracerebral cavernoma Hypophyseal adenoma Brain abscess Nonlesional epilepsy surgeries Other brain surgeries Spinal screw stabilization
The age of the patients ranged from 4 to 81 years (mean 42.0 years). There were 165 female and 181 male patients. The most common pathological diagnoses are shown in Table 1. Detailed analysis of a battery of postoperative questions concerning the benefits in operative planning, appreciation of anatomy, lesion location, safety of surgery, duration of the surgical procedure, complication rate, and postoperative course of the patients with neurological outcome or survival time, the surgeons’ opinions about the neuronavigation, and enhanced surgical confidence were performed.
3. Results The number of image-guided surgical procedures was slightly increasing with years. There were 61, 75, 106, and 97 operations in the years 1997, 1998, 1999, and 2000, respectively. Image-guidance could not be used because of technical problems in the four procedures. Significant brainshift that was interfering with the operation occurred surprisingly seldom (three procedures with exaggerated edema around a tumor). A broad range of intracranial neurosurgical procedures was seen to benefit from image guidance, including 317 craniotomies and 29 spinal fusion procedures. The preliminary main advantages of the image-guidance were: 1. 2. 3. 4. 5. 6.
Possibility of preoperative planning of the surgical approach; accurate skin incision and craniotomy; unequivocal intra-operative detection of deep seated lesions (Fig. 1); determination of resection boundaries (Fig. 1); minimized traumatization in and near eloquent areas. In glioma surgery, the system provided exact definition of radiologically determined resection borders. 7. In meningeoma surgery, it allowed a tailored craniotomy, dura opening and resection. 8. In metastasis surgery, it provided a safe approach to deep located lesions especially in eloquent areas.
K. Holl et al. / International Congress Series 1230 (2001) 99–101
101
Fig. 1. Image-guidance enables unequivocal intra-operative detection of deep-seated lesions and determination of resection boundaries.
9. Combination with functional evaluation methods provided multimodal informationguidance in epilepsy and lesional cases.
4. Conclusion Neuronavigation, today a routine method in neurosurgery, has not yet been systematically assessed in direct comparison with conventional microsurgical techniques. The aim of the present study was the direct comparison of the impact of neuronavigation on neurosurgical procedures regarding time consumption, lesion location, extent of tumor removal, neurological outcome and survival. We believe that image-guided surgical technology plays a significant role in contemporary neurosurgery, and that with new developments its widespread adoption in practice will be realised in the near future.
Clinical benefit of image guidance in neurosurgery Kurt Holl *, Willibald Wies, Gabriele Wurm ¨ . Landesnervenklinik Wagner Jauregg, Wagner Jauregg Weg 15, Neurosurgical Department, O.O 4021 Linz, Austria
Keywords: Neurosurgery; Neuronavigation; Computer-assisted surgery; Benefit
1. Purpose Neuronavigational devices with three-dimensional image-reconstruction allow accurate preoperative planning and intra-operative localization of regions of interest and risk zones. Therefore, image-guidance nowadays is considered to have its justification in or adjacent to eloquent areas of the brain. This especially holds true for elective surgery in areas of complex anatomy. On the other hand, little is known about the clinical benefit for the patient. In literature, there is a lack of follow-up studies that concern duration of the surgical procedure, complication rate, and postoperative course of the patients with neurological outcome or survival time. In order to fully assess the advantages of image guided techniques over conventional planning and surgery in selected cases, detailed evaluation of the imageguided procedures of our neurosurgical department was carried out.
2. Patients and methods In our department, we use the optically guided systems SNS by Zeiss and Stealth Station by Medtronic. Over a 43-month period (April 1997 to December 2000), 346 image-guided procedures have been performed in our neurosurgical department. There were 316 cranial (291 by ZEISS and 25 by Stealth Station) and 29 spinal (all by Stealth Station) procedures. Image-guidance was based on CT-imaging in 31 cases, on MRimaging in 281 cases, and on CT-MR-fusion in 5 cases. *
Corresponding author. Tel.: +43-732-6921; fax: +43-732-6921-2811. E-mail address: mailto:[email protected] (K. Holl).
0531-5131/01/$ – see front matter D 2001 Elsevier Science B.V. All rights reserved. PII: S 0 5 3 1 - 5 1 3 1 ( 0 1 ) 0 0 0 2 3 - 1
100
K. Holl et al. / International Congress Series 1230 (2001) 99–101
Table 1 Image-guided operative procedures 89 49 35 27 5 5 72 35 29
Intracerebral glioma Cranial metastase Meningeoma Intracerebral cavernoma Hypophyseal adenoma Brain abscess Nonlesional epilepsy surgeries Other brain surgeries Spinal screw stabilization
The age of the patients ranged from 4 to 81 years (mean 42.0 years). There were 165 female and 181 male patients. The most common pathological diagnoses are shown in Table 1. Detailed analysis of a battery of postoperative questions concerning the benefits in operative planning, appreciation of anatomy, lesion location, safety of surgery, duration of the surgical procedure, complication rate, and postoperative course of the patients with neurological outcome or survival time, the surgeons’ opinions about the neuronavigation, and enhanced surgical confidence were performed.
3. Results The number of image-guided surgical procedures was slightly increasing with years. There were 61, 75, 106, and 97 operations in the years 1997, 1998, 1999, and 2000, respectively. Image-guidance could not be used because of technical problems in the four procedures. Significant brainshift that was interfering with the operation occurred surprisingly seldom (three procedures with exaggerated edema around a tumor). A broad range of intracranial neurosurgical procedures was seen to benefit from image guidance, including 317 craniotomies and 29 spinal fusion procedures. The preliminary main advantages of the image-guidance were: 1. 2. 3. 4. 5. 6.
Possibility of preoperative planning of the surgical approach; accurate skin incision and craniotomy; unequivocal intra-operative detection of deep seated lesions (Fig. 1); determination of resection boundaries (Fig. 1); minimized traumatization in and near eloquent areas. In glioma surgery, the system provided exact definition of radiologically determined resection borders. 7. In meningeoma surgery, it allowed a tailored craniotomy, dura opening and resection. 8. In metastasis surgery, it provided a safe approach to deep located lesions especially in eloquent areas.
K. Holl et al. / International Congress Series 1230 (2001) 99–101
101
Fig. 1. Image-guidance enables unequivocal intra-operative detection of deep-seated lesions and determination of resection boundaries.
9. Combination with functional evaluation methods provided multimodal informationguidance in epilepsy and lesional cases.
4. Conclusion Neuronavigation, today a routine method in neurosurgery, has not yet been systematically assessed in direct comparison with conventional microsurgical techniques. The aim of the present study was the direct comparison of the impact of neuronavigation on neurosurgical procedures regarding time consumption, lesion location, extent of tumor removal, neurological outcome and survival. We believe that image-guided surgical technology plays a significant role in contemporary neurosurgery, and that with new developments its widespread adoption in practice will be realised in the near future.