scholarly journals Cerebral tumor resection assisted by electromagnetic tracking frameless stereotactic system

2018 ◽  
Vol 21 (2) ◽  
pp. 93-98
Author(s):  
Eduardo E. Lovo ◽  
Rafael Martínez Cortez ◽  
Rodolfo Milla Flor ◽  
Héctor Moreira
Keyword(s):  
Tumor Resection ◽  
Intraoperative Ultrasound ◽  
Tumor Location ◽  
Cerebral Tumor ◽  
Advantages And Disadvantages ◽  
Stereotactic System ◽  
Brain Tumor Resection ◽  
Eloquent Cortex ◽  
Tracking Device

Introduction: Electromagnetic (EM) technology used as a tracking device in neurosurgery is relatively new and less common than its optical counterpart: only a few companies manufacture such devices. The main objective is to describe the technology that is used in EM tracking (Compass Cygnus), and its advantages and disadvantages in brain tumor resection as it is incorporated in a neuro-oncology program. Methods: We used the Compass Cygnuss-PFS frameless stereotactic system which performs EM tracking (EMFSS); we analyzed the technology used in the system and describe how a procedureis carried out, signalizing its advantages and disadvantages. We then report our initial experience in tumor resections using this technology from august 2008 to january 2009 in the Neuro-oncology Program of the Hospital de Diagnóstico of El Salvador. Results: The EMFSS operates by using a Flock ofBirds Technology (FOB). Twenty patients were operated on using the EMFSS: 18 of them harbored a tumor either primary or secondary in origin. Its precision was considered adequate in 16 cases (88.8 %) when compared to non-mobile, non-deformable structures (cranial base floor, tentorium, falx, etc). Intraoperative ultrasound in two cases: it was considered inadequatedue to brain shift/deformation, in two cases (11.1%) and a re-registration process had to be carried out during surgery. Tumor location was: 5 (27.7%) in non eloquent, 8 (44.4%) near eloquent, and 5 (27.7%) in eloquent cortex. Volumetric tumor resection was 87% (40-100%). Five patients (27.7%) had complications, 4 (80%) of them transient and resolved during 30 day follow-up. One (5.5%) patient had definite neurological worsening. Thirty day mortality was 0. Preoperative Karnofsky Physiological Score (KPS) and at discharge and at one month follow up was 80 (60-90), 80 (60-90) and 80(60-100) respectively. Conclusions: EM tracking is a reliable system when its accuracy is tested against non-mobile structures and ultrasound. It is compact and the “line of sight” does not have to be taken into consideration. Its big advantages are “tailored” craniotomy design and spatial orientations in deepseated tumors, where ultrasound is not efective; its biggest limitation is its incapacity to re-register with anatomical points or landmarks and image fusion or transition.

Diffuse Pigmented Villonodular Synovitis Around the Ankle

2018 ◽  
Vol 108 (2) ◽  
pp. 140-144 ◽  
Author(s):  
Keiichi Muramatsu ◽  
Ryuta Iwanaga ◽  
Yasuhiro Tominaga ◽  
Takahiro Hashimoto ◽  
Toshihiko Taguchi
Keyword(s):  
Ankle Joint ◽  
Tumor Resection ◽  
Tumor Location ◽  
Pigmented Villonodular Synovitis ◽  
Growth Patterns ◽  
Treatment Modalities ◽  
Villonodular Synovitis ◽  
Lateral Incision ◽  
Pigmented Villonodular

Background: Pigmented villonodular synovitis (PVNS) is a rare disorder around the ankle joint. The optimal treatment for diffuse-type PVNS is still controversial because of the high incidence of recurrence. We present the clinical features of our patients and review the current diagnostic and treatment modalities. Methods: Five patients with PVNS located around the ankle were surgically treated. In three patients, diffuse PVNS arose from the ankle joint, and in the other two it arose from the calcaneocuboid and intercuneiform joints. The average follow-up time after surgery was 2.9 years (range, 2–4.6 years). Results: The average time between onset of pain and diagnosis of PVNS was 6.4 years (range, 4–10 years). Arthrotomic tumor resection was performed in all of the patients. In the three patients with ankle joint PVNS, both medial and lateral approaches were used. One patient experienced mild infection at the surgical site, but this healed conservatively. No tumor recurrences had occurred after minimum follow-up of 2 years, although mild pain persisted in the three patients with ankle PVNS. Conclusions: Diagnosis of diffuse PVNS is frequently delayed due to vague symptoms and variable growth patterns. Orthopedic clinicians should be aware of the existence of this lesion, and it should be suspected in patients with persistent ankle swelling. To prevent tumor recurrence, accurate evaluation of tumor location and careful operative planning are mandatory. A combined surgical approach involving medial and lateral incision is necessary to expose the entire joint cavity.

Prospective study of awake craniotomy used routinely and nonselectively for supratentorial tumors

2007 ◽  
Vol 107 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Demitre Serletis ◽  
Mark Bernstein
Keyword(s):  
General Anesthesia ◽  
Brain Mapping ◽  
Tumor Resection ◽  
Tumor Location ◽  
Awake Craniotomy ◽  
Neurological Deficits ◽  
Wound Complications ◽  
Presenting Symptoms ◽  
Eloquent Cortex ◽  
Supratentorial Tumors

Object The authors prospectively assessed the value of awake craniotomy used nonselectively in patients undergoing resection of supratentorial tumors. Methods The demographic features, presenting symptoms, tumor location, histological diagnosis, outcomes, and complications were documented for 610 patients who underwent awake craniotomy for supratentorial tumor resection. Intraoperative brain mapping was used in 511 cases (83.8%). Mapping identified eloquent cortex in 115 patients (22.5%) and no eloquent cortex in 396 patients (77.5%). Results Neurological deficits occurred in 89 patients (14.6%). In the subset of 511 patients in whom brain mapping was performed, 78 (15.3%) experienced postoperative neurological worsening. This phenomenon was more common in patients with preoperative neurological deficits or in those individuals in whom mapping successfully identified eloquent tissue. Twenty-five (4.9%) of the 511 patients suffered intraoperative seizures, and two of these individuals required intubation and induction of general anesthesia after generalized seizures occurred. Four (0.7%) of the 610 patients developed wound complications. Postoperative hematomas developed in seven patients (1.1%), four of whom urgently required a repeated craniotomy to allow evacuation of the clot. Two patients (0.3%) required readmission to the hospital soon after being discharged. There were three deaths (0.5%). Conclusions Awake craniotomy is safe, practical, and effective during resection of supratentorial lesions of diverse pathological range and location. It allows for intraoperative brain mapping that helps identify and protect functional cortex. It also avoids the complications inherent in the induction of general anesthesia. Awake craniotomy provides an excellent alternative to surgery of supratentorial brain lesions in patients in whom general anesthesia has been induced.

Tentorial Meningiomas: Clinical Results in 81 Patients Treated Microsurgically

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 108-118 ◽  
Author(s):  
Hischam Bassiouni ◽  
Anja Hunold ◽  
Siamak Asgari ◽  
Dietmar Stolke
Keyword(s):  
Tumor Resection ◽  
Clinical Results ◽  
Tumor Location ◽  
Morbidity And Mortality ◽  
Surgical Morbidity ◽  
Presenting Symptoms ◽  
Simpson Grade ◽  
Tentorial Meningioma ◽  
Neuroimaging Data

Abstract OBJECTIVE: Even during the microsurgical era, tentorial meningiomas present a formidable surgical challenge when tumor involves critical neurovascular structures. We report our experience with tentorial meningioma with regard to clinical presentation, diagnostic workup, microsurgical technique, complications, and follow-up results. METHODS: In a retrospective study, we reviewed the medical charts, neuroimaging data, and follow-up data of patients treated microsurgically for tentorial meningioma in our department between January 1989 and June 2002. Patients were routinely scheduled for clinical and radiological follow-up 6 months and 1 year after surgery. Thereafter, follow-up was performed every 1 or 2 years on the basis of the results of each follow-up examination. RESULTS: The main presenting symptoms of the patients (69 women and 12 men) were headache (75%), dizziness (49%), and gait disturbance (46%). The leading neurological signs were gait ataxia (52%) and cranial nerve deficits (28%). Extent of tumor resection was Simpson Grade I in 29 patients, Grade II in 45 patients, Grade III in 1 patient, Grade IV in 4 patients, and unknown in 2 patients. Permanent surgical morbidity and mortality were 19.8 and 2.5%, respectively. Clinical and magnetic resonance imaging follow-up was available in 74 patients for a period ranging from 1 to 13 years (mean, 5.9 yr). Of these, 64 patients (86%) have resumed normal life activity. Seven patients had tumor recurrence and four underwent reoperation. CONCLUSION: Careful preoperative planning of the surgical approach tailored to tumor location and extent is a prerequisite to achieve radical microsurgical tumor resection with minimal morbidity and mortality. Resection of an infiltrated but patent venous sinus is not recommended.

Neuronavigation by Intraoperative Three-dimensional Ultrasound: Initial Experience during Brain Tumor Resection

Neurosurgery ◽  
2002 ◽  
Vol 50 (4) ◽  
pp. 804-812 ◽  
Author(s):  
Geirmund Unsgaard ◽  
Steinar Ommedal ◽  
Tomm Muller ◽  
Aage Gronningsaeter ◽  
Toril A. Nagelhus Hernes
Keyword(s):  
Brain Tumor ◽  
Imaging Modality ◽  
Intraoperative Imaging ◽  
Tumor Resection ◽  
Three Dimensional ◽  
Ultrasound Image ◽  
Intraoperative Ultrasound ◽  
Cost Effective ◽  
Ultrasound Images ◽  
Brain Tumor Resection

Abstract OBJECTIVE: Three-dimensional (3-D) ultrasound is an intraoperative imaging modality used in neuronavigation as an alternative to magnetic resonance imaging (MRI). This article summarizes 4 years of clinical experience in the use of intraoperative 3-D ultrasound integrated into neuronavigation for guidance in brain tumor resection. METHODS: Patients were selected for inclusion in the study on the basis of the size and location of their lesion. Preoperative 3-D MRI data were registered and used for planning as in other conventional neuronavigation systems. Intraoperative 3-D ultrasound images were acquired three to six times, and tumor resection was guided on the basis of these updated 3-D images. RESULTS: Intraoperative 3-D ultrasound represents a good solution to the problem of brain shift in neuronavigation because it easily provides an updated, and hence more accurate, map of the patient's true anatomy in all phases of the operation. Ultrasound makes it possible to follow the progression of the operation, and it improves the radicality of tumor resection by detecting tumor tissue that would remain if the imaging technology had not been used (in 53% of the cases). Integration of 3-D ultrasound with navigation technology solves the orientation problem experienced previously with two-dimensional ultrasound in neurosurgery. The technology makes it possible to directly compare intraoperative ultrasound and MRI data regarding visualization of the lesion. Ultrasound image quality is useful for guiding surgical procedures. CONCLUSION: Intraoperative 3-D ultrasound seems to provide a time- and cost-effective way to update high-quality 3-D maps used in neuronavigation.

scholarly journals Hyperacute Infarct on Intraoperative Diffusion Imaging of Pediatric Brain Tumor Surgery

2019 ◽  
Vol 46 (5) ◽  
pp. 550-558 ◽  
Author(s):  
Christine Saint-Martin ◽  
Sergio Apuzzo ◽  
Ayat Salman ◽  
Jean-Pierre Farmer
Keyword(s):  
Brain Tumor ◽  
Brain Area ◽  
Tumor Resection ◽  
Pediatric Brain Tumor ◽  
Intraoperative Mri ◽  
Control Group ◽  
Post Surgery ◽  
Brain Tumor Resection ◽  
Pediatric Brain

ABSTRACT:Background:Brain neoplasms are the second-most prevalent cancer of childhood for which surgical resection remains the main treatment. Intraoperative MRI is a useful tool to optimize brain tumor resection. It is, however, not known whether intraoperative MRI can detect complications such as hyperacute ischemic infarcts.Methods:A retrospective analysis of pre- and intraoperative MRIs including DWI sequence and correlation with early and 3-month postoperative MRIs was conducted to evaluate the incidence of hyperacute arterial infarct during pediatric brain tumor resection. Patient demographics, pathological type, tumor location, resection type as well as preoperative tumoral vessel encasement, evolution of the area of restricted diffusion were collected and analyzed comparatively between the group with acute infarct and the control group. Extent of the hyperacute infarct was compared to both early postsurgical and 3-month follow-up MRIs.Results:Of the 115 cases, 13 (11%) developed a hyperacute arterial ischemic infarct during brain tumor resection. Tumoral encasement of vessels was more frequent in the infarct group (69%) compared to 25.5% in the control group. Four cases showed additional vessel irregularities on intraoperative MRI. On early follow-up, the infarcted brain area had further progressed in six cases and was stable in seven cases. No further progression was noted after the first week post-surgery.Conclusions:Hyperacute infarcts are not rare events to complicate pediatric brain tumor resection. Tumoral encasement of the circle of Willis vessels appears to be the main risk factor. Intraoperative DWI underestimates the final extent of infarcted tissue compared to early postsurgical MRI.

Subtotal resection of cervical schwannomas and growth rate of residual tumors

2019 ◽  
Vol 30 (6) ◽  
pp. 794-800 ◽  
Author(s):  
Sung Mo Ryu ◽  
Sun-Ho Lee ◽  
Kyung Min Lee ◽  
Whan Eoh ◽  
Eun-Sang Kim
Keyword(s):  
Growth Rate ◽  
Tumor Size ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Tumor Location ◽  
Subtotal Resection ◽  
Percentage Increase ◽  
Mri Findings ◽  
The Mean

OBJECTIVEThe objective of this study was to elucidate the features and surgical outcomes of cervical schwannomas.METHODSThe authors retrospectively reviewed the records of 90 patients who underwent surgically treated cervical schwannomas from January 1995 to December 2017, with an emphasis on MRI findings such as tumor location, tumor size, extent of tumor resection, and growth of a residual tumor.RESULTSThis study included 51 men (56.7%) and 39 women (43.3%) with a mean age of 44.5 years (range 7–77 years). Dumbbell-shaped tumors comprised 62 (68.9%) of 90 cases and gross-total resection (GTR) was achieved in 59 (65.6%) of 90 cases. All nondumbbell tumors (n = 28) underwent GTR. Only 1 case of recurrence in the GTR group showed a gradual increase in size (by 8.9 mm) during the 150-month follow-up period. For the regrowth patients in the subtotal resection group, the mean percentage increase in tumor size was 47.5% ± 33.1% and the mean growth rate was 5.8 ± 4.6 mm/year during the 20.3-month follow-up period. However, the size of residual tumor spontaneously decreased by a mean of 8.3% ± 11.1% during the 48.4-month follow-up period in the nonregrowth group.CONCLUSIONSThese findings suggested that frequent MRI follow-up examinations are required for residual schwannomas in the cervical spine for at least 2 years, and continuous MRI follow-ups are also required thereafter.

Extended Anterior Inferior Approach to Endoscopic Medial Maxillectomy for Maxillary Sinus Lesions

2021 ◽  
pp. 194589242110253
Author(s):  
Alice E. Huang ◽  
Christopher M. Low ◽  
Janalee K. Stokken
Keyword(s):  
Maxillary Sinus ◽  
Tumor Recurrence ◽  
Tumor Resection ◽  
Nasolacrimal Duct ◽  
Surgical Morbidity ◽  
Advantages And Disadvantages ◽  
Case Series Study ◽  
Patient Reported ◽  
Medial Maxillectomy

Background Myriad open and endoscopic approaches are employed to resect maxillary sinus lesions, each with associated advantages and disadvantages. The inferior and anterior portion of the sinus remains a challenging space to access. Objectives To describe the extended anterior inferior approach to endoscopic medial maxillectomy (EAMM) as a novel and valuable addition to a stepwise approach for minimizing surgical morbidity without compromising tumor outcomes. To report the outcomes of patients treated with this approach. Methods A retrospective case series study of 9 patients who underwent EAMM between 2016 and 2019 at a tertiary care referral center was performed. The endoscopic technique is described. The duration of follow-up ranged from 1 to 53 months. Intraoperative steps, including transection of the nasolacrimal duct and execution of an intraoperative dacryocystorhinostomy, were reviewed. Postoperative outcomes, including patient symptoms at follow-up and tumor recurrence, were recorded. Results Adequate exposure with gross total tumor resection or margin-negative tumor resection was achieved in all cases. Sparing of the nasolacrimal duct was achieved in 2 patients. No patients reported persistent epiphora, empty nose syndrome, or changes in cosmesis such as alar or nasal tip collapse. One patient reported unilateral V2 hypoesthesia at 6 months postoperatively that had resolved by his next follow-up 18 months after surgery. Postoperative tumor surveillance was achieved by endoscopic examinations in all patients and there was no evidence of tumor recurrence at a median follow-up of 22 months. Conclusions The EAMM provides improved access to the inferior–posterior–medial maxillary sinus. This approach minimizes the risk of hypoesthesia and change in cosmesis present in other approaches, and obviates division of the nasolacrimal duct for inferior, posterior–medial attached lesions. This progressive escalation of approach for maxillary sinus lesions minimizes injury to nasal and nasolacrimal structures without compromising tumor outcomes.

scholarly journals Posterior approach to ventrally and dorsally located spinal meningiomas

2021 ◽  
Vol 18 (1) ◽  
pp. 61-69
Author(s):  
G. B. Grygoriev ◽  
V. Yu. Cherebillo ◽  
D. V. Goranchuk
Keyword(s):  
Posterior Approach ◽  
Tumor Resection ◽  
Tumor Location ◽  
Duration Of Surgery ◽  
Csf Leakage ◽  
Spinal Meningiomas ◽  
Intradural Extramedullary ◽  
Favorable Neurological Outcome ◽  
Total Tumor Removal

Objective. To analyze the outcomes of posterior approach in the surgery of intradural extramedullary meningiomas located ventrally and dorsally in relation to the spinal cord denticulate ligaments.Material and Methods. The study included 29 patients with spinal intradural meningiomas operated on using posterior approach. Patients were divided depending on the tumor location relative to the denticulate ligaments into ventral (n = 13) and dorsal (n = 16) groups. The surgery duration, the degree of tumor resection, clinical outcomes, the presence and nature of complications, and the frequency of recurrence were assessed.Results. The average follow-up period was 29 (6 to 61) months. Total tumor removal was performed in 93.1 % of cases: 11 cases (84.6 %) in ventral group and 16 cases (100.0 %) in dorsal group. The average duration of surgery was 136 minutes for dorsal meningiomas and 181 minutes for ventral meningiomas (p < 0.05). Complications in the form of CSF leakage were registered in two patients (6.9 %). In 11 (84.6 %) patients with ventral meningiomas and 15 (93.7 %) patients with dorsal meningiomas, an improvement or preservation of neurological functions at the pre-surgery level was observed. Recurrences were observed in two patients (6.9 %).Conclusion. Patients with spinal meningiomas have a favorable neurological outcome and a low recurrence rate. Surgery is more complicated in patients with ventral meningiomas. In most cases, unilateral posterior approach is applicable for both ventral and dorsal meningiomas.

scholarly journals Complications of ventricular entry during craniotomy for brain tumor resection

2017 ◽  
Vol 127 (2) ◽  
pp. 426-432 ◽  
Author(s):  
Jessin K. John ◽  
Adam M. Robin ◽  
Aqueel H. Pabaney ◽  
Richard A. Rammo ◽  
Lonni R. Schultz ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Subdural Hematoma ◽  
Intraventricular Hemorrhage ◽  
External Ventricular Drain ◽  
Tumor Resection ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Brain Tumor Resection

OBJECTIVERecent studies have demonstrated that periventricular tumor location is associated with poorer survival and that tumor location near the ventricle limits the extent of resection. This finding may relate to the perception that ventricular entry leads to further complications and thus surgeons may choose to perform less aggressive resection in these areas. However, there is little support for this view in the literature. This study seeks to determine whether ventricular entry is associated with more complications during craniotomy for brain tumor resection.METHODSA retrospective analysis of patients who underwent craniotomy for tumor resection at Henry Ford Hospital between January 2010 and November 2012 was conducted. A total of 183 cases were reviewed with attention to operative entry into the ventricular system, postoperative use of an external ventricular drain (EVD), subdural hematoma, hydrocephalus, and symptomatic intraventricular hemorrhage (IVH).RESULTSPatients in whom the ventricles were entered had significantly higher rates of any complication (46% vs 21%). Complications included development of subdural hygroma, subdural hematoma, intraventricular hemorrhage, subgaleal collection, wound infection, urinary tract infection/deep venous thrombosis, hydrocephalus, and ventriculoperitoneal (VP) shunt placement. Specifically, these patients had significantly higher rates of EVD placement (23% vs 1%, p < 0.001), hydrocephalus (6% vs 0%, p = 0.03), IVH (14% vs 0%, p < 0.001), infection (15% vs 5%, p = 0.04), and subgaleal collection (20% vs 4%, p < 0.001). It was also observed that VP shunt placement was only seen in cases of ventricular entry (11% vs 0%, p = 0.001) with 3 of 4 of these patients having a large ventricular entry (defined here as entry greater than a pinhole [< 3 mm] entry). Furthermore, in a subset of glioblastoma patients with and without ventricular entry, Kaplan-Meier estimates for survival demonstrated a median survival time of 329 days for ventricular entry compared with 522 days for patients with no ventricular entry (HR 1.13, 95% CI 0.65–1.96; p = 0.67).CONCLUSIONSThere are more complications associated with ventricular entry during brain tumor resection than in nonviolated ventricular systems. Better strategies for management of periventricular tumor resection should be actively sought to improve resection and survival for these patients.

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