title: Localization techniques in resection of deep seated cavernous angiomas - review and reevaluation of frame based stereotactic approaches.
abstract: BACKGROUND
  Providing high accuracy is crucial in neurosurgery especially for resection of deep seated small cerebral pathologies such as cavernous angiomas. The goal of the present series was to reevaluate the feasibility, accuracy, efficacy and safety of frame-based, stereotactically guided resection for patients suffering from small deep-seated cavernous angiomas. Additionally a review of the literature on navigational tools in cavernoma surgery is provided comparing different navigation strategies.
  
  
  METHODS
  Ten patients with deep-seated, small intracranial, cavernous angiomas being subject to frame-based, stereotactically aided resection are included in this survey. Based on the stereotactic-fused image, set entry and target point aimed at the rim of the cavernoma were calculated. A minicraniotomy (< 3 cm in diameter) was performed followed by positioning of the stereotactic needle. Following the needle in situ the cavernous angioma was localized and resected. Assets and drawbacks of the stereotactic-aided approach were evaluated, patients were analyzed for surgery-related neurological deficits and completeness of resection.
  
  
  RESULTS
  Complete resection was achieved in all ten patients verified by post-surgery MRI imaging. The surgical procedure itself was only slightly aggravated by the stereotactic equipment. No adverse events such as bleedings or infections were observed in our series.
  
  
  CONCLUSIONS
  Stereotactically guided, minimally invasive resection of deep seated and small cavernous angiomas is accurate and effective. The frame-based stereotactic guidance requires some additional time and effort which seems justified only for deep seated and small cavernous angiomas. Frameless neuronavigation is a common tool in cavernoma surgery and its spatial resolution is sufficient for the majority of cases.
authors.affiliation: Department of Neurosurgery, Heinrich-Heine University, Düsseldorf, Germany. slotty@med.uni-duesseldorf.de
authors.forename: P J
authors.initials: PJ
authors.lastname: Slotty
authors.forename: C
authors.initials: C
authors.lastname: Ewelt
authors.forename: S
authors.initials: S
authors.lastname: Sarikaya-Seiwert
authors.forename: H-J
authors.initials: HJ
authors.lastname: Steiger
authors.forename: J
authors.initials: J
authors.lastname: Vesper
authors.forename: D
authors.initials: D
authors.lastname: Hänggi
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006392:Hemangioma, Cavernous / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D013238:Stereotaxic Techniques; D055815:Young Adult