title: Frame-based and frameless stereotaxy in the localization of cavernous angiomas.
abstract: Cavernous angiomas are mostly small intracranial vascular lesions which can be intraoperatively localized by sonography or stereotactic methods. This paper compares the results of cavernous angioma surgery localized by frame-based vs frameless techniques. Thirty-nine patients with cortical or subcortical lobar cavernoma were operated on by a microsurgical trans-sulcal approach. The localization of the lesion was performed in 19 (49%) patients by frame-based technique and in 20 (51%) patients by frameless navigation. In 22 (56%) of the patients, the cavernomas were located in an eloquent cortical area. Ten of 22 of these lesions were localized by frame-based stereotaxy and 12/22 by frameless navigation. The patients demonstrated the following preoperative symptoms: seizures 20 (51%), hemorrhage 18 (46%), focal neurologic deficit 11 (28%), and headache three (7%), and three (7%) were asymptomatic. Thirteen of 19 patients localized with frame-based stereotaxy were postoperatively asymptomatic or their preoperative neurological symptoms improved. Four of 19 had a transitory neurologic deficit and 2/19 a permanent worsening. Seventeen of 20 patients localized by frameless navigation were asymptomatic or neurologically improved. Three out of 20 suffered from a transient neurologic deficit. Regarding the seizures, 14 (70%) patients were postoperatively free of seizures, three (15%) were improved, and three (15%) were unchanged. The frameless navigation was superior regarding the flexibility for approaches along the skull base and midline, and the frame-based method was superior regarding the accuracy for very small lesions (less than 7 mm). In other cases, both methods were equal. Frame-based and frameless stereotactic methods are useful in the localization of small cavernous angiomas. They make it possible to remove cavernous angiomas in eloquent cortical regions with low risk of a permanent neurologic deficit.
authors.affiliation: Department of Neurosurgery, Johannes Gutenberg University, 55131 Mainz, Germany. grunert@nc.klinik.uni-mainz.de
authors.forename: P
authors.initials: P
authors.lastname: Grunert
authors.forename: K
authors.initials: K
authors.lastname: Charalampaki
authors.forename: M
authors.initials: M
authors.lastname: Kassem
authors.forename: H
authors.initials: H
authors.lastname: Boecher-Schwarz
authors.forename: R
authors.initials: R
authors.lastname: Filippi
authors.forename: P
authors.initials: P
authors.lastname: Grunert
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006392:Hemangioma, Cavernous / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D038361:Neuronavigation / Q000009:adverse effects*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index