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.
Roessler
K
K
Neurosurgical Clinic, University of Vienna Medical School, Austria. karl.roessler@telecom.at
Ungersboeck
K
K
Czech
T
T
Aichholzer
M
M
Dietrich
W
W
Goerzer
H
H
Matula
C
C
Koos
W T
WT
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