Minim Invas Neurosur
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Minim Invas Neurosur · Aug 2006
Case ReportsFatal intratumoral hemorrhage immediately after gamma knife radiosurgery for brain metastases: case report.
Radiosurgical treatment of brain tumors is sometimes considered to be free from significant acute complications or adverse effects. A rare case of fatal intratumoral hemorrhage immediately after gamma knife radiosurgery (GKR) for brain metastasis is reported. A 46-year-old woman with lung cancer complicated by systemic dissemination experienced an acute episode of headache, speech disturbances, and right-side hemiparesis. ⋯ Urgent CT disclosed a massive hemorrhage in the left cerebellar hemisphere in the vicinity of the radiosurgically treated lesion. The patient died 4 days later and autopsy confirmed the presence of intratumoral hemorrhage. In conclusion, GKR for metastatic brain tumors should not be considered as a risk-free procedure and, while extremely rare, even fatal complications can occur after treatment.
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Minim Invas Neurosur · Aug 2006
Morphological study of the spinal canal content for subarachnoid endoscopy.
This study was designed to examine the morphology of the spinal dural sac and contents, using magnetic resonance imaging in order to define the inner geometrical dimensions that confine the manoeuvre of an endoscope inserted in the lumbar region and along the thoracic and cervical spine. ⋯ The findings presented here expand our knowledge of the spinal canal's morphology, and show that an endoscope designed to travel within the subarachnoid space must be smaller than 2.5 mm in diameter.
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Minim Invas Neurosur · Aug 2006
Application of intraoperative 3D ultrasound during navigated tumor resection.
Intraoperative 3D ultrasound (3D-iUS) may enhance the quality of neuronavigation by adding information about brain shift and tumor remnants. The aim of our study was to prove the concept of 3D ultrasound on the basis of technical and human effects. A 3D-ultrasound navigation system consisting of a standard personal computer containing a video grabber card in combination with an optical tracking system (NDI Polaris) and a standard ultrasound device (Siemens Omnia) with a 7.5 MHz probe was used. 3D-iUS datasets were acquired after craniotomy, at different subsequent times of the procedure and overlaid with preoperative MRI. ⋯ The introduction of 3D ultrasound has increased the value of neuronavigation substantially, making it possible to update several times during surgery and minimize the problem of brain shift. Configuration of both the 3D iUS based on a standard ultrasound system and the MR navigation system is time- and especially cost-effective. Faster navigational datasets and more intuitive image-guided surgery enable novel and user-friendly display techniques.
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Minim Invas Neurosur · Aug 2006
Application of neuronavigation system to brain tumor surgery with clinical experience of 420 cases.
A new era of neurosurgery has recently been unveiled with the advent of image-guided surgery. The use of neuronavigation is beginning to have a significant impact on a variety of intracranial procedures. Herein, we report our clinical experience using a neuronavigation system with different surgical applications and techniques for a variety of brain tumors. ⋯ We utilized this system to effectively make bone flaps, to detect critically located, deep-seated, subcortical, skull-base and skull bone tumors, and to operate on intraparenchymal lesions with grossly unclear margins, such as gliomas. We also performed tumor biopsy using the combination of a conventional stereotactic biopsy instrument and an endoscope. The application of the neuronavigation system not only revealed benefits for operative planning, appreciation of anatomy, lesion location and the safety of surgery, but also greatly enhanced surgical confidence.