title: MKM-guided resection of diffuse brainstem neoplasms.
abstract: OBJECTIVE
  Some primary brainstem tumors, when extensive, are considered inoperable. We wanted to assess the value of robotic image-guided microscopic surgery in the resection of these tumors and to improve survival and quality of life for these patients.
  
  
  METHODS
  Two patients with extensive brainstem tumors were evaluated at our center. They previously underwent several biopsies, attempted partial resections, radiotherapy and shunting. They presented with progressive neurological deterioration, 'coma vigil' for several months, and required life-supporting measures prior to surgery. Both patients underwent frameless stereotactic craniotomy using a MKM robotic microscope, intraoperative neurophysiological monitoring, and extensive resection of their recurrent brainstem tumors.
  
  
  RESULTS
  In the immediate weeks after surgery, both patients became interactive and regained major motor and cranial nerve deficits present prior to surgery. Nine months after surgery, 1 patient succumbed to pneumonia. At 2 years after the operation, 1 patient has maintained his neurological status and showed no recurrence on imaging studies.
  
  
  CONCLUSIONS
  Image-guided surgery with an MKM microscope allows surgical outlines to be injected in the microscope viewer and facilitates resection of extensive brainstem tumors previously considered inoperable.
authors.affiliation: Cedars-Sinai Medical Center, Functional Neurosurgery Unit, Los Angeles, CA 90048, USA. levesque@cshs.org
authors.forename: M F
authors.initials: MF
authors.lastname: Lévesque
authors.forename: F
authors.initials: F
authors.lastname: Parker
mesh_terms: D000328:Adult; D020295:Brain Stem Neoplasms / Q000175:diagnosis / Q000601:surgery*; D004806:Ependymoma / Q000175:diagnosis / Q000601:surgery*; D018325:Hemangioblastoma / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D012371:Robotics; D013238:Stereotaxic Techniques