Neuronavigation in a developing country: a pilot study of efficacy and limitations in intracranial surgery

An Observational Comparative Study to Evaluate the Use of Image-Guided Surgery in the Management and Outcome of Supratentorial Intracranial Space-Occupying Lesions

Objectives

The objective of this article is to study the effect of neuronavigation on the outcome of surgery for supratentorial tumors, such as the extent of resection, size of craniotomy, and overall morbidity and mortality by comparing with conventional excision.

Methods

A total of 50 patients undergoing intracranial surgery for supratentorial space-occupying lesions from 2020 to 2022 were included in the study. One intervention group consisted of patients undergoing surgical resection of supratentorial tumors utilizing image guidance versus the control group, which consisted of patients undergoing surgical excision of supratentorial tumor excision without image guidance. Parameters used to compare the outcome were the extent of resection of the lesions, craniotomy size, and overall morbidity and mortality.

Results and Conclusion

There was no significant reduction in craniotomy size or prolongation of operative duration with the use of neuronavigation. There was no significant difference in postoperative hospital stay between the two groups. Neuronavigation-assisted cases did not show any significant reduction in the occurrence of postoperative neurological deficits or any reduction of overall morbidity and mortality.

A Novel Frameless Laser Stereotaxis System for Neurosurgical Interventions

OBJECTIVE

The aim of the article is to introduce a novel laser-based frameless stereotactic device that can locate intracranial lesions quickly and with computed tomograph (CT)/magnetic resonance imaging (MRI) films. Preliminary experiences of application in 416 cases are also summarized.

METHODS

From August in 2020 to October in 2022, a total of 416 cases of new minimalist laser stereotactic surgery have been performed on 415 patients. Of the 415 patients, 377 had intracranial hematomas, while the remaining cases were brain tumors or brain abscesses. Postoperative CT was used to evaluate the accuracy of catheterization of 405 patients according to the MISTIE study. The duration time of locating was recorded. Rebleeding refers to the definition: Compared with preoperative CT, the relative volume of postoperative hematoma increases by >33% or absolute volume increase >12.5 mL.

RESULTS

According to postoperative CT, the accuracy of 405 stereotactic catheterization cases was good in 346 cases (85.4%) and suboptimal in 59 cases (14.6%), with no poor results. Postoperative rebleeding occurred in 4 spontaneous cerebral hemorrhage cases and 1 brain biopsy case. The average localization time of supratentorial lesions was 13.2 minutes in the supine position, 21.5 minutes in the lateral position, and 27.6 minutes in the prone position.

CONCLUSIONS

The new laser-based frameless stereotactic device is simple in principle and convenient in positioning operation of brain hematoma and abscess puncture, brain biopsy and tumor surgery, and appropriate to the precision requirements in most craniocerebral surgery.

A new simple brain segmentation method for extracerebral intracranial tumors

Normal brain segmentation is available via FreeSurfer, Vbm, and Ibaspm software. However, these software packages cannot perform segmentation of the brain for patients with brain tumors. As we know, damage from extracerebral tumors to the brain occurs mainly by way of pushing and compressing while leaving the structure of the brain intact. Three-dimensional (3D) imaging, augmented reality (AR), and virtual reality (VR) technology have begun to be applied in clinical practice. The free medical open-source software 3D Slicer allows us to perform 3D simulations on a computer and requires little user interaction. Moreover, 3D Slicer can integrate with the third-party software mentioned above. The relationship between the tumor and surrounding brain tissue can be judged, but accurate brain segmentation cannot be performed using 3D Slicer. In this study, we combine 3D Slicer and FreeSurfer to provide a novel brain segmentation method for extracerebral tumors. This method can help surgeons identify the “real” relationship between the lesion and adjacent brain tissue before surgery and improve preoperative planning.

Diagnostic accuracy of the [-2]Pro-PSA and Prostate Health Index versus the Gleason score for determining the aggressiveness of prostate cancer: a systematic review protocol

REVIEW QUESTIONS.

Burden of brain tumors in low- and middle-income countries: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to determine the best available evidence on the burden of brain tumors in low- and middle-income countries (LAMICs). More specifically, the objective is to determine the incidence and prevalence rates for brain tumors in LAMICs.

The Assessment of Distortion in Neurosurgical Image Overlay Projection

BACKGROUND

Numerous studies have demonstrated the superiority of neuronavigation during neurosurgical procedures compared to non-neuronavigation-based procedures. Limitations to neuronavigation systems include the need for the surgeons to avert their gaze from the surgical field and the cost of the systems, especially for hospitals in developing countries. Overlay projection of imaging directly onto the patient allows localization of intracranial structures. A previous study using overlay projection demonstrated the accuracy of image coregistration for a lesion in the temporal region but did not assess image distortion when projecting onto other anatomical locations. Our aim is to quantify this distortion and establish which regions of the skull would be most suitable for overlay projection.

METHODS

Using the difference in size of a square grid when projected onto an anatomically accurate model skull and a flat surface, from the same distance, we were able to calculate the degree of image distortion when projecting onto the skull from the anterior, posterior, superior, and lateral aspects. Measuring the size of a square when projected onto a flat surface from different distances allowed us to model change in lesion size when projecting a deep structure onto the skull surface.

RESULTS

Using 2 mm as the upper limit for distortion, our results show that images can be accurately projected onto the majority (81.4%) of the surface of the skull.

CONCLUSION

Our results support the use of image overlay projection in regions with ≤2 mm distortion to assist with localization of intracranial lesions at a fraction of the cost of existing methods.

Cerebral biopsy: comparison between frame-based stereotaxy and neuronavigation in an oncology center

Treatment of intracranial tumoral lesions is related to its correct histological diagnostic. We present a retrospective analysis of 32 patients submitted to 36 cerebral biopsies using neuronavigation and 44 patients using frame-based stereotaxy. Mean age was 46.6 and 49.3 years old respectively. Sex distribution in both groups was 50% for each. Most of lesions were lobar in both groups. Diagnostic yielding was 91.7% and 83.4%, respectively (p=0.26). We found in the postoperative CT scans intracranial hemorrhages in 13.8% cases of the first group and 9.8% cases in the second. Most of them were mild post-operative hemorrages in the biopsy site. There was one death related to the procedure in each group. Astrocytomas and metastatic adenocarcinomas were the most frequent diagnosis. Diagnostic yielding and the number of postoperative hemorrhage and death were similar on both groups and the same found in the literature.