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Sadahiro H, Fujitsuku S, Sugimoto K, Kawano A, Fujii N, Nomura S, Takahashi M, Ishihara H. Bony Surface-Matching Registration of Neuronavigation with Sectioned 3-Dimensional Skull in Prone Position. World Neurosurg 2024; 187:236-242.e1. [PMID: 38750893 DOI: 10.1016/j.wneu.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Neuronavigation has become an essential system for brain tumor resections. It is sometimes difficult to obtain accurate registration of the neuronavigation with the patient in the prone position. Bony surface-matching registration should be more precise than skin surface-matching registration; however, it is difficult to establish bony registration with limited exposed bone. We created a new bony surface-matching method to a sectioned 3-dimensional (3D) virtual skull in a neuronavigation system and registered with a sectioned 3D skull. In this study, the bony surface-matching with sectioned 3D registration is applied to provide precise registration for brain tumor resection in the prone position. METHODS From May 2023 to April 2024, 17 patients who underwent brain tumor resection in the prone position were enrolled. The navigation system StealthStation S8 (Medtronic, Dublin, Ireland) was used. Bony surface-matching registration with a whole 3D skull in a neuronavigation system was performed. Next, a sectioned 3D skull was made according to the surgical location to compare with the whole 3D skull registration. A phantom model was also used to validate the whole and sectioned 3D skull registration. RESULTS Whole 3D skull registration was successful for only 2 patients (11.8%). However, sectioned 3D skull registration was successful for 16 patients (94.1%). The examinations with a phantom skull model also showed superiority of sectioned 3D skull registration to whole 3D skull registration. CONCLUSIONS Sectioned 3D skull registration was superior to whole 3D skull registration. The sectioned 3D skull method could provide accurate registration with limited exposed bone.
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Affiliation(s)
- Hirokazu Sadahiro
- Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan.
| | - Shunsuke Fujitsuku
- Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Kazutaka Sugimoto
- Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Akiko Kawano
- Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Natsumi Fujii
- Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Sadahiro Nomura
- Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan
| | - Masakazu Takahashi
- Graduate School of Innovation of Technology Management, Yamaguchi University, Yamaguchi, Japan
| | - Hideyuki Ishihara
- Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Yamaguchi, Japan
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Menezes DR, de Lima L, Mansilla R, Conci A, Rueda F, Velarde LGC, Landeiro JA, Acioly MA. A prospective study on the usefulness of high-resolution intraoperative infrared thermography in intracranial tumors. Front Surg 2024; 11:1386722. [PMID: 38933651 PMCID: PMC11199714 DOI: 10.3389/fsurg.2024.1386722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/30/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Infrared thermography (IT) is a non-invasive real-time imaging technique with potential application in different areas of neurosurgery. Despite technological advances in the field, intraoperative IT (IIT) has been an underestimated tool with scarce reports on its usefulness during intracranial tumor resection. We aimed to evaluate the usefulness of high-resolution IIT with static and dynamic thermographic maps for transdural lesion localization, and diagnosis, to assess the extent of resection, and the occurrence of perioperative acute ischemia. Methods In a prospective study, 15 patients affected by intracranial tumors (six gliomas, four meningiomas, and five brain metastases) were examined with a high-resolution thermographic camera after craniotomy, after dural opening, and at the end of tumor resection. Results Tumors were transdurally located with 93.3% sensitivity and 100% specificity (p < 0.00001), as well as cortical arteries and veins. Gliomas were consistently hypothermic, while metastases and meningiomas exhibited highly variable thermographic maps on static (p = 0.055) and dynamic (p = 0.015) imaging. Residual tumors revealed non-specific static but characteristic dynamic thermographic maps. Ischemic injuries were significantly hypothermic (p < 0.001). Conclusions High-resolution IIT is a non-invasive alternative intraoperative imaging method for lesion localization, diagnosis, assessing the extent of tumor resection, and identifying acute ischemia changes with static and dynamic thermographic maps.
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Affiliation(s)
- Diego Rodrigues Menezes
- Division of Neurosurgery, Fluminense Federal University, Rio de Janeiro, Brazil
- Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Lázaro de Lima
- Division of Neurosurgery, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Raíssa Mansilla
- Division of Neurosurgery, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Aura Conci
- Department of Computer Science, Fluminense Federal University, Rio de Janeiro, Brazil
| | - Fernanda Rueda
- Division of Radiology, Fluminense Federal University, Rio de Janeiro, Brazil
| | | | | | - Marcus André Acioly
- Division of Neurosurgery, Fluminense Federal University, Rio de Janeiro, Brazil
- Postgraduation Program in Neurology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Bopp MHA, Grote A, Gjorgjevski M, Pojskic M, Saß B, Nimsky C. Enabling Navigation and Augmented Reality in the Sitting Position in Posterior Fossa Surgery Using Intraoperative Ultrasound. Cancers (Basel) 2024; 16:1985. [PMID: 38893106 PMCID: PMC11171013 DOI: 10.3390/cancers16111985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Despite its broad use in cranial and spinal surgery, navigation support and microscope-based augmented reality (AR) have not yet found their way into posterior fossa surgery in the sitting position. While this position offers surgical benefits, navigation accuracy and thereof the use of navigation itself seems limited. Intraoperative ultrasound (iUS) can be applied at any time during surgery, delivering real-time images that can be used for accuracy verification and navigation updates. Within this study, its applicability in the sitting position was assessed. Data from 15 patients with lesions within the posterior fossa who underwent magnetic resonance imaging (MRI)-based navigation-supported surgery in the sitting position were retrospectively analyzed using the standard reference array and new rigid image-based MRI-iUS co-registration. The navigation accuracy was evaluated based on the spatial overlap of the outlined lesions and the distance between the corresponding landmarks in both data sets, respectively. Image-based co-registration significantly improved (p < 0.001) the spatial overlap of the outlined lesion (0.42 ± 0.30 vs. 0.65 ± 0.23) and significantly reduced (p < 0.001) the distance between the corresponding landmarks (8.69 ± 6.23 mm vs. 3.19 ± 2.73 mm), allowing for the sufficient use of navigation and AR support. Navigated iUS can therefore serve as an easy-to-use tool to enable navigation support for posterior fossa surgery in the sitting position.
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Affiliation(s)
- Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
| | - Alexander Grote
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
| | - Marko Gjorgjevski
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
| | - Mirza Pojskic
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
| | - Benjamin Saß
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
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Ogiwara T, Nitta J, Fujii Y, Watanabe G, Kuwabara H, Agata M, Kobayashi H, Miyaoka Y, Kitamura S, Hanaoka Y, Goto T, Iwaya M, Hongo K, Horiuchi T. A preliminary study of the diagnostic efficacy and safety of the novel boring biopsy for brain lesions. Sci Rep 2022; 12:4387. [PMID: 35288608 PMCID: PMC8921193 DOI: 10.1038/s41598-022-08366-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Existing methods for biopsy of intraparenchymal brain lesions, including stereotactic biopsy and open block biopsy, have advantages and disadvantages. We propose a novel biopsy method, called “boring biopsy,” which aims to overcome the drawbacks of each conventional method. This method is less invasive and allows obtaining continuous specimens of sufficient volume. We aimed to assess the feasibility and efficacy of using boring biopsy for intraparenchymal brain lesions. We included 26 consecutive patients who underwent boring biopsy for intraparenchymal lesions. Columnar continuous specimens from the surface of the normal brain tissue to the tumor margin and the center of the lesion were obtained using the boring biopsy method. We used a catheter introducer with original modifications to create a cylindrical biopsy tool for surgery. Columnar continuous specimens were successfully obtained. Histopathological diagnosis was based on cellular changes and differentiation from normal tissues to the core of the lesion and established in all cases. No permanent deficits, major adverse outcomes, or deaths were observed. This novel technique may improve diagnostic accuracy and reduce invasiveness associated with brain biopsy. This method may become the next standard procedure, particularly in some cases where histological evaluation is paramount, and conventional biopsy methods are not suitable.
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Affiliation(s)
- Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Junpei Nitta
- Department of Neurosurgery, Kobayashi Neurosurgical Hospital, 1-5-21 Miwa, Nagano, 380-0803, Japan
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Gen Watanabe
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Haruki Kuwabara
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Masahiro Agata
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Hideki Kobayashi
- Department of Neurosurgery, Kobayashi Neurosurgical Hospital, 1-5-21 Miwa, Nagano, 380-0803, Japan
| | - Yoshinari Miyaoka
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Satoshi Kitamura
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.,Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Miyamaeku, Kawasaki, 216-8511, Japan
| | - Mai Iwaya
- Department of Laboratory Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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Ogiwara T, Fujii Y, Hanaoka Y, Kitamura S, Kuwabara H, Funato K, Inomata Y, Yamazaki D, Yamazaki K, Murase H, Yokota A, Hardian RF, Goto T, Hongo K, Horiuchi T. Intraoperative Image-Guided Surgery for Gliomas in the Smart Cyber Operating Theater (SCOT®): A Preliminary Clinical Application. World Neurosurg 2022; 160:e314-e321. [PMID: 35026453 DOI: 10.1016/j.wneu.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Various devices exist for glioma image-guided surgery to improve tumor resection. These devices work as standalone units, making the flow of operative information complicated and disjointed. A novel networked operating room, the "Smart Cyber Operating Theater (SCOT®)," has been developed, integrating standalone medical devices using the "OPeLiNK®" communication interface. Herein, we report and evaluate the impact of the SCOT® for glioma surgery and our initial experiences. METHODS Patients with gliomas who underwent tumor resection in the SCOT® between July 2018 and June 2021 were retrospectively reviewed. Various types of intraoperative information were integrated, managed, and shared with the surgical strategy desk using the OPeLiNK®. Patients' demographics, tumor characteristics, treatment details, and outcomes were obtained. The impact of the SCOT® system was evaluated. RESULTS Twenty-seven patients with a mean age of 48.6 years (range 13 - 88 years) met the inclusion criteria. We successfully completed all the surgical procedures using the SCOT®. The mean operation time was 420.6 minutes (225 - 667 min). Gross total resection was accomplished in 13 patients (48.1%), subtotal resection in 4 (14.8%), and partial resection in 10 (37.0%). The main surgeon in the operating room and other neurosurgeons at the strategy desk shared and discussed the information in real time during the procedures. CONCLUSIONS The use of the SCOT® was demonstrated to be safe and feasible in glioma surgery. This study suggests that the SCOT® may improve surgical outcomes and educational impact by sharing information in real-time with the strategy desk.
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Affiliation(s)
- Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Kitamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Haruki Kuwabara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kohei Funato
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuki Inomata
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Ken Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hiromu Murase
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akifumi Yokota
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Wurzer A, Minchev G, Cervera-Martinez C, Micko A, Kronreif G, Wolfsberger S. The endonasal patient reference tracker: a novel solution for accurate noninvasive electromagnetic neuronavigation. J Neurosurg 2021; 134:1951-1958. [PMID: 32679564 DOI: 10.3171/2020.4.jns20394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Electromagnetic (EM) navigation provides the advantages of continuous guidance and tip-tracking of instruments. The current solutions for patient reference trackers are suboptimal, as they are either invasively screwed to the bone or less accurate if attached to the skin. The authors present a novel EM reference method with the tracker rigidly but not invasively positioned inside the nasal cavity. METHODS The nasal tracker (NT) consists of the EM coil array of the AxiEM tracker plugged into a nasal tamponade, which is then inserted into the inferior nasal meatus. Initially, a proof-of-concept study was performed on two cadaveric skull bases. The stability of the NT was assessed in simulated surgical situations, for example, prone, supine, and lateral patient positioning and skin traction. A deviation ≤ 2 mm was judged sufficiently accurate for clinical trial. Thus, a feasibility study was performed in the clinical setting. Positional changes of the NT and a standard skin-adhesive tracker (ST) relative to a ground-truth reference tracker were recorded throughout routine surgical procedures. The accuracy of the NT and ST was compared at different stages of surgery. RESULTS Ex vivo, the NT proved to be highly stable in all simulated surgical situations (median deviation 0.4 mm, range 0.0-2.0 mm). In 13 routine clinical cases, the NT was significantly more stable than the ST (median deviation at procedure end 1.3 mm, range 0.5-3.0 mm vs 4.0 mm, range 1.2-11.2 mm, p = 0.002). The loss of accuracy of the ST was highest during draping and flap fixation. CONCLUSIONS Application of the EM endonasal patient tracker was found to be feasible with high procedural stability ex vivo as well as in the clinical setting. This innovation combines the advantages of high precision and noninvasiveness and may, in the future, enhance EM navigation for neurosurgery.
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Affiliation(s)
- Ayguel Wurzer
- 1Department of Neurosurgery, Medical University Vienna; and
| | - Georgi Minchev
- 1Department of Neurosurgery, Medical University Vienna; and
| | | | | | - Gernot Kronreif
- 2Austrian Center of Medical Innovation and Technology, Wiener Neustadt, Austria
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Liu P, Nie H, Wang Z, Yao B, Li JH, Zhou J. Application of Enhanced Recovery after Surgical Treatment of the Occipitocervical Region. Orthop Surg 2021; 13:1269-1276. [PMID: 33951307 PMCID: PMC8274187 DOI: 10.1111/os.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The concept of enhanced recovery after surgery (ERAS) has been proposed to provide guidance for the improved postoperative rehabilitation of patients with occipitocervical region disease (ORD). Methods This study retrospectively investigated 208 consecutive patients (116 men and 92 women) ranging in age from 22 to 76 years with ORD between July 2014 and June 2017 in our medical center, who were divided into three groups that received different preoperative, intraoperative, and postoperative management plans: traditional group (n = 73), ameliorated group (n = 70), and ERAS group (n = 65). We compiled a range of data relating to demographics and postoperative changes in hemoglobin and albumin, surgery duration, intraoperative blood loss, number of postoperative hospitalization days and expenses, readmission rates, and visual analog scale pain symptoms. Data were statistically evaluated using one‐way analysis of variance with Student–Newman–Keuls‐q post hoc tests or chi‐square tests. Results There were no significant differences in terms of age (P = 0.235), gender (P = 0.691), body mass index (P = 0.723), American Society of Anesthesiologists grade (0.747), lesion character (P = 0.337) and lesion site (P = 0.957) between the three groups. Within a 6 months follow‐up period, there was no significant difference between the three groups in terms of surgery duration (P = 0.225), blood loss (P = 0.172), changes in hemoglobin (P = 0.255) and albumin (P = 0.178). However, postoperative hospitalization days (P = 0.000), postoperative costs (P = 0.019) and improvement of pain symptoms (P = 0.000) in ERAS group were significantly lower or higher than those in traditional group or ameliorated group, respectively. There were 29 (39.73%), 22 (31.43%), and 13 (20.00%), recorded cases of postoperative complications in traditional group, ameliorated group and ERAS group, respectively; complications in ERAS group were significantly lower than those in other two groups (P = 0.043). Moreover, all of the complications were mitigated effectively by the infusion of fluid, analgesia, treatment of infections, or antiemetic medications. There were 2 (2.74%), 3 (4.29%) and 2 (3.08%), recorded cases of re‐admission in traditional group, ameliorated group and ERAS group, respectively, but there were no statistically significant differences when compared across the three groups (P = 0.866). Conclusions ERAS can provide benefits when it applied to patients undergoing ORD surgery mainly in terms of reducing postoperative complications, however, ERAS does not increase the economic burden of patients or decrease the risk of readmission.
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Affiliation(s)
- Peng Liu
- Department of Orthopaedic Surgery, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Hai Nie
- Department of Orthopaedic Surgery, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Zhuan Wang
- Department of Orthopaedic Surgery, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Bao Yao
- Department of Orthopaedic Surgery, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Jia-Hong Li
- Department of Orthopaedic Surgery, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Ji Zhou
- Department of Orthopaedic Surgery, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
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Fujii Y, Ogiwara T, Goto T, Kanaya K, Hara Y, Hanaoka Y, Hardian RF, Hongo K, Horiuchi T. Microscopic Navigation-Guided Fence Post Technique for Maximal Tumor Resection During Glioma Surgery. World Neurosurg 2021; 151:e355-e362. [PMID: 33887499 DOI: 10.1016/j.wneu.2021.04.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The fence post technique, which involves insertion of catheters as fence posts around a tumor, has been widely used to demarcate the tumor border for maximal resection of intraparenchymal tumors, such as gliomas. However, a standard procedure for fence post insertion has not been established, and there are some limitations. To overcome this problem, a simple microscopic navigation-guided fence post technique was developed. The feasibility and efficacy of this novel technique during glioma surgery were assessed. METHODS The microscopic navigation-guided fence post technique was used in 46 glioma surgeries performed in 42 patients. Intraoperatively, the preplanned trajectory was overlaid on the microscopic surgical field, and the microscope angle was changed until the entry and target points of the trajectory overlapped. A fence post catheter was inserted as planned under microscopic view, and the tumor was resected with fence post guidance. Preoperative tumor characteristics and surgical outcomes were evaluated. RESULTS Mean age of patients was 50 years (range, 16-78 years), and 19 (45%) of 42 patients were women. Maximal safe resection was successfully achieved in 45 surgeries (97.8%), which was planned preoperatively with identification of the tumor border with fence posts without adverse effects of brain shift. No surgical complications attributable to fence post insertion occurred. CONCLUSIONS Clinical experience indicated that the microscopic navigation-guided fence post technique, in which fence posts can be placed without requiring the surgeon to take their eyes off the microscope, is safe and useful in glioma surgery.
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Affiliation(s)
- Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Saint Marianna University School of Medicine, Kawasaki, Japan
| | - Kohei Kanaya
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yosuke Hara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | | | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Ina Central Hospital, Ina, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Dho YS, Kim YJ, Kim KG, Hwang SH, Kim KH, Kim JW, Kim YH, Choi SH, Park CK. Positional effect of preoperative neuronavigational magnetic resonance image on accuracy of posterior fossa lesion localization. J Neurosurg 2020; 133:546-555. [PMID: 31323639 DOI: 10.3171/2019.4.jns1989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the positional effect of MRI on the accuracy of neuronavigational localization for posterior fossa (PF) lesions when the operation is performed with the patient in the prone position. METHODS Ten patients with PF tumors requiring surgery in the prone position were prospectively enrolled in the study. All patients underwent preoperative navigational MRI in both the supine and prone positions in a single session. Using simultaneous intraoperative registration of the supine and prone navigational MR images, the authors investigated the images' accuracy, spatial deformity, and source of errors for PF lesions. Accuracy was determined in terms of differences in the ability of the supine and prone MR images to localize 64 test points in the PF by using a neuronavigation system. Spatial deformities were analyzed and visualized by in-house-developed software with a 3D reconstruction function and spatial calculation of the MRI data. To identify the source of differences, the authors investigated the accuracy of fiducial point localization in the supine and prone MR images after taking the surface anatomy and age factors into consideration. RESULTS Neuronavigational localization performed using prone MRI was more accurate for PF lesions than routine supine MRI prior to prone position surgery. Prone MRI more accurately localized 93.8% of the tested PF areas than supine MRI. The spatial deformities in the neuronavigation system calculated using the supine MRI tended to move in the posterior-superior direction from the actual anatomical landmarks. The average distance of the spatial differences between the prone and supine MR images was 6.3 mm. The spatial difference had a tendency to increase close to the midline. An older age (> 60 years) and fiducial markers adjacent to the cervical muscles were considered to contribute significantly to the source of differences in the positional effect of neuronavigation (p < 0.001 and p = 0.01, respectively). CONCLUSIONS This study demonstrated the superior accuracy of neuronavigational localization with prone-position MRI during prone-position surgery for PF lesions. The authors recommend that the scan position of the neuronavigational MRI be matched with the surgical position for more precise localization.
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Affiliation(s)
- Yun-Sik Dho
- 1Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
| | - Young Jae Kim
- 2Department of Biomedical Engineering, School of Medicine, Gachon University, Incheon; and
| | - Kwang Gi Kim
- 2Department of Biomedical Engineering, School of Medicine, Gachon University, Incheon; and
| | - Sung Hwan Hwang
- 1Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
| | - Kyung Hyun Kim
- 1Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
| | - Jin Wook Kim
- 1Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
| | - Yong Hwy Kim
- 1Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
| | - Seung Hong Choi
- 3Department of Radiology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Kee Park
- 1Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul
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Ogiwara T, Goto T, Hara Y, Hongo K. Real-Time Navigation-Guided Drilling Technique for Skull Base Surgery in the Middle and Posterior Fossae. J Neurol Surg B Skull Base 2018; 79:S334-S339. [PMID: 30210987 DOI: 10.1055/s-0038-1667044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022] Open
Abstract
Objective The usefulness of the bony surface registration method for navigation system image-guided surgery in the lateral or prone position has been reported. This study was performed to evaluate the efficacy of our new real-time navigation-guided drilling technique with bony surface registration for skull base surgery in the middle and posterior fossae. Methods The study included 29 surgeries for skull base tumors that required drilling of the petrous bone between January 2015 and December 2017 in Shinshu University Hospital. A navigation system was used for drilling of the petrous bone as follows: (1) some labyrinthine structures were marked by color in the source image and superimposed on the navigation image on the workstation preoperatively; (2) bony surface registration was performed with a three-dimensional (3D) skull reconstruction model in the operating room; (3) the petrous bone was drilled under navigation guidance with real-time view-through confirmation of 3D color-marked labyrinthine structures with observation under a microscopic operative view. Results Real-time identification of some structures in the petrous bone was performed, and adequate and precise drilling of the petrous bone was achieved without the risk of labyrinthine perforation or stress. Using this method, surgeons do not need to alternate their gaze between the surgical field and the navigation screen. Conclusions Due to the development of bony surface registration, this new technique is useful for drilling petrous bone in the middle and posterior fossa skull base surgeries.
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Affiliation(s)
- Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yosuke Hara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Ogiwara T, Nagm A, Hanaoka Y, Nishikawa A, Goto T, Horiuchi T, Hongo K. Management of hypertrophied dural lesions: Is surgery a better option? J Neurol Sci 2017; 381:245-249. [PMID: 28991691 DOI: 10.1016/j.jns.2017.08.3268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/04/2017] [Accepted: 08/31/2017] [Indexed: 11/27/2022]
Abstract
It is often difficult to definitively diagnose dural lesions with hypertrophy as they exhibit nonspecific imaging findings and clinical symptoms. Most cases require histopathological evaluation with surgical intervention (such as biopsy). However, complications related to surgical interventions remain as matter of concern. Herein, we analyzed and verified the significance of surgery in 39 patients with hypertrophic dural lesions who were histopathologically diagnosed with surgical interventions. Specimens of dural lesions were obtained successfully, and it was possible to make a definitive diagnosis for each case based on histopathological findings. All patients tolerate the procedures well, and there were no evidences of surgery-related complications during surgical approach to the dura mater. Preoperative and pathological diagnoses varied in eight cases. Our results indicate that histopathological evaluation is important for distinguishing diseases showing dural hypertrophy even if surgical invasiveness is concerned. Neurosurgeons should not hesitate to perform surgery for management of dural lesions with hypertrophy in order to achieve accurate diagnosis.
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Affiliation(s)
- Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Alhusain Nagm
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan; Department of Neurosurgery, Al-Azhar University Faculty of Medicine, Nasr City, Cairo, Egypt
| | - Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akihiro Nishikawa
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Nagm A, Ogiwara T, Goto T, Chiba A, Hongo K. Neuroendoscopy via an Extremely Narrow Foramen of Monro: A Case Report. NMC Case Rep J 2016; 4:37-42. [PMID: 28664024 PMCID: PMC5364906 DOI: 10.2176/nmccrj.cr.2016-0157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/18/2016] [Indexed: 11/25/2022] Open
Abstract
Herein, safe and reliable neuroendoscopic biopsy via an extremely narrow foramen of Monro (ENFM) for a non-hydrocephalic patient with hypothalamic and pineal region tumors was successfully applied. A 17-year-old boy presented with hypothalamic manifestations attributed to hypothalamic and pineal region tumors. Small ventricles were seen. Intraoperatively, to advance different diameter steerable fiberscopes via ENFM, the third ventricle was flushed to induce a moment increase in the intraventricular pressure with subsequent dilatation of FM. Postoperative course was uneventful. Histopathological studies revealed a yolk sac tumor. Adjuvant therapy was applied. Follow-up neuroimaging disclosed marvellous improvement of the condition. His symptoms gradually improved.
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Affiliation(s)
- Alhusain Nagm
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and.,Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr city, Cairo, Egypt
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
| | - Akihiro Chiba
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
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Duan H, Hara Y, Goto T, Chiba A, Hongo K. Giant cavernous malformation in the ventrolateral midbrain with extension into the thalamus: a case report of a paramedian supracerebellar transtentorial approach. Acta Neurochir (Wien) 2016; 158:1533-8. [PMID: 27328840 DOI: 10.1007/s00701-016-2870-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022]
Abstract
Cavernous malformations (CMs) of the midbrain and thalamus are relatively rare and particularly difficult to be resected given their location in eloquent tissues. Here, we report a case of a 14-year-old boy who experienced repeated and progressive right hemiparesis. Image examinations showed a gradually enlarged CM originated in the left ventrolateral midbrain extending to the left thalamus with repeated hemorrhage. By performing a paramedian supracerebellar transtentorial approach, the CM was totally removed, and the patient recovered without any new neurological deficit. The authors' experience suggests that this approach is eminent in treating giant lesions involving the ventrolateral midbrain and thalamus.
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Affiliation(s)
- Hongzhou Duan
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
- Department of Neurosurgery, Peking University First Hospital, Xicheng District, Beijing, China
| | - Yosuke Hara
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
| | - Akihiro Chiba
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
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