Contour-guided brain tumor surgery using a stereotactic navigating microscope.
OBJECTIVE
The benefit of intraoperative radiological data integration in approach planning and resection of brain tumors using a computer navigating microscope (MKM Zeiss) was investigated.


METHODS
Since February 1995, out of 86 MKM-guided surgical procedures, 53 contour-guided tumor cases (24 females, 29 males, mean age 51.6) including 16 metastasis, 14 glioblastomas, 10 low-grade gliomas, 6 anaplastic gliomas, 3 meningiomas and 4 others were performed. The preoperative planning was based on CT in 42 cases and Magnetic Resonance Tomography (MRT) in 11 cases using skin markers (4-9, mean 6). Neuroradiologically defined tumor contours were transferred into the ocular of the microscope and projected into the operating field during the procedure.


RESULTS
The advantages of the system were: (1) preoperative approach planning; (2) minimal, accurate skin incision and craniotomy; (3) intraoperative detection of deep seated lesions or lesion components; (4) determination of lesion boundaries; (5) minimized traumatization in/near eloquent areas. Mean registration accuracy improved from 5.3 mm for the first 10 cases up to 2 mm for the last 18 cases. In glioma surgery, the system provided exact definition of radiologically planned resection borders. In meningioma surgery, it allowed a tailored craniotomy, dura opening and resection, lowering the risk of recurrence. In metastasis surgery, it provided a safe approach to deep and eloquent located lesions.


CONCLUSIONS
Contour-guided operation planning and resection guidance using the investigated navigating microscope provides additional security to avoid some potential risks in brain tumor surgery.
Neurosurgical Clinic, University of Vienna Medical School, Austria. karl.roessler@telecom.at
K
K
Roessler
K
K
Ungersboeck
T
T
Czech
M
M
Aichholzer
W
W
Dietrich
H
H
Goerzer
C
C
Matula
W T
WT
Koos
D000328:Adult; D001254:Astrocytoma / Q000601:surgery; D001932:Brain Neoplasms / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000601:surgery; D005910:Glioma / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation; D007430:Intraoperative Care / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000601:surgery; D008853:Microscopy / Q000295:instrumentation; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D009493:Neurosurgery / Q000295:instrumentation*; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed