title: Image-guided lateral suboccipital approach: part 2-impact on complication rates and operation times.
abstract: OBJECTIVE
  Image-guidance systems are widely available for surgical planning and intraoperative navigation. Recently, three-dimensional volumetric image rendering technology that increasingly applies in navigation systems to assist neurosurgical planning, e.g., for cranial base approaches. However, there is no systematic clinical study available that focuses on the impact of this image-guidance technology on outcome parameters in suboccipital craniotomies.
  
  
  METHODS
  A total of 200 patients with pathologies located in the cerebellopontine angle were reviewed, 100 of whom underwent volumetric neuronavigation and 100 of whom underwent treatment without intraoperative image guidance. This retrospective study analyzed the impact of image guidance on complication rates (venous sinus injury, venous air embolism, postoperative morbidity caused by venous air embolism) and operation times for the lateral suboccipital craniotomies performed with the patient in the semi-sitting position.
  
  
  RESULTS
  This study demonstrated a 4% incidence of injury to the transverse-sigmoid sinus complex in the image-guided group compared with a 15% incidence in the non-image-guided group. Venous air embolisms were detected in 8% of the image-guided patients and in 19% of the non-image-guided patients. These differences in terms of complication rates were significant for both venous sinus injury and venous air embolism (P < 0.05). There was no difference in postoperative morbidity secondary to venous air embolism between both groups. The mean time for craniotomy was 21 minutes in the image-guided group and 39 minutes in non-image-guided group (P = 0.036).
  
  
  CONCLUSIONS
  Volumetric image guidance provides fast and reliable three-dimensional visualization of sinus anatomy in the posterior fossa, thereby significantly increasing speed and safety in lateral suboccipital approaches.
authors.affiliation: Department of Neurosurgery, University Hospital Tübingen, Charlottenstrasse 37/1, 72070 Tübingen, Germany. alireza.gharabaghi@uni-tuebingen.de
authors.forename: Alireza
authors.initials: A
authors.lastname: Gharabaghi
authors.forename: Steffen K
authors.initials: SK
authors.lastname: Rosahl
authors.forename: Günther C
authors.initials: GC
authors.lastname: Feigl
authors.forename: Sam
authors.initials: S
authors.lastname: Safavi-Abbasi
authors.forename: Javad M
authors.initials: JM
authors.lastname: Mirzayan
authors.forename: Stefan
authors.initials: S
authors.lastname: Heckl
authors.forename: Ramin
authors.initials: R
authors.lastname: Shahidi
authors.forename: Marcos
authors.initials: M
authors.lastname: Tatagiba
authors.forename: Madjid
authors.initials: M
authors.lastname: Samii
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D002533:Cerebral Angiography / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D009778:Occipital Lobe / Q000000981:diagnostic imaging* / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D013382:Subtraction Technique; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*