Minimally invasive neurosurgery within a 0.5 tesla intraoperative magnetic resonance scanner using an off-line neuro-navigation system.
OBJECTIVE
We evaluated an advanced concept for patient-based navigation during minimally invasive neurosurgical procedures.


METHODS
An infrared-based, off-line neuro-navigation system (LOCALITE, Bonn, Germany) was applied during operations within a 0.5 T intraoperative MRI scanner (iMRI) (Signa SF, GE Medical Systems, Milwaukee, WI, USA) in addition to the conventional real-time system. The three-dimensional (3D) data set was acquired intraoperatively and up-dated when brain-shift was suspected. Twenty-three patients with subcortical lesions were operated upon with the aim to minimise the operative trauma.


RESULTS
Small craniotomies (median diameter 30 mm, mean diameter 27 mm) could be placed exactly. In all cases, the primary goal of the operation (total resection or biopsy) was achieved in a straightforward procedure without permanent morbidity. The navigation system could be easily used without technical problems. In contrast to the real-time navigation mode of the MR system, the higher quality as well as the real-time display of the MR images reconstructed from the 3D reference data provided sufficient visual-manual coordination.


CONCLUSIONS
The system combines the advantages of conventional neuro-navigation with the ability to adapt intraoperatively to the continuously changing anatomy. Thus, small and/or deep lesions can be operated upon in straightforward minimally invasive operations.
Mursch
K
K
Neurochirurgische Klinik, Zentralklinik, Bad Berka, Germany. k.mursch.nec@zentralklinik-bad-berka.de
Gotthardt
T
T
Kröger
R
R
Bublat
M
M
Behnke-Mursch
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D019635:Neurosurgical Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted