title: Multimodal Neuronavigation in Microsurgery Resection of BrainStem Tumors.
abstract: BACKGROUND
  Microsurgery is a common treatment of brainstem tumors. However, misdirection, vascular damage, nerves injuries, paralysis, even death are all well-known complications, and the risk of adverse events is more likely in less experienced operators. This study was aimed to validate the accuracy of multimodal neuronavigation during microsurgery resection of brainstem tumors.
  
  
  METHODS
  Ten patients with brainstem tumors underwent preoperative MRI, diffusion tensor imaging, computed tomography, three-dimensional print, and images loaded into the neuronavigation platform were used for its segmentation and preoperative planning. After patients' registration and subsequent surgical exposure, each segmented brain element was validated by manual placement of the navigation probe to the target.
  
  
  RESULTS
  Preoperative images of the brain matched with three-dimensional print and neuronavigation played important role in all patients. Excellent correspondence between image-based segmentation and microscope view was also evident at the surface of tumors and at the tumor-normal gland interfaces.
  
  
  CONCLUSIONS
  Multimodal navigation is a safe and effective method in surgery for patients with brain stem tumors. Our preliminary study is conducted to encourage for future more research with larger numbers of patients.
authors.affiliation: *Department of Pharmacology, AnHui Medical University†Department of Neurosurgery‡Department of Pathology§Department of Radiology, Fist Affiliated Hospital of AnHui Medical University, Hefei, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Zhang
authors.forename: WenMing
authors.initials: W
authors.lastname: Hong
authors.forename: Yan
authors.initials: Y
authors.lastname: Guo
authors.forename: QianYing
authors.initials: Q
authors.lastname: Guo
authors.forename: XiaoPeng
authors.initials: X
authors.lastname: Hu
mesh_terms: D000328:Adult; D020295:Brain Stem Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D056324:Diffusion Tensor Imaging; D004806:Ependymoma / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000601:surgery*; D020786:Hemangioma, Cavernous, Central Nervous System / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D064847:Multimodal Imaging; D038361:Neuronavigation / Q000379:methods*; D066330:Printing, Three-Dimensional; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed