Electromagnetic navigation-guided surgery in the semi-sitting position for posterior fossa tumours: a safety and feasibility study

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• 作者：Elvis J. Hermann ; Ioannis Petrakakis ; Manolis Polemikos ; Peter Raab…
• 关键词：Electromagnetic navigation (EM) ; Semi ; sitting position ; Posterior fossa tumour
• 刊名：Acta Neurochirurgica
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：157
• 期：7
• 页码：1229-1237
• 全文大小：547 KB
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• 作者单位：Elvis J. Hermann (1)
  Ioannis Petrakakis (1)
  Manolis Polemikos (1)
  Peter Raab (2)
  Zafer Cinibulak (1)
  Makoto Nakamura (1)
  Joachim K. Krauss (1)
  
  1. Department of Neurosurgery, Medical School Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Germany
  2. Institute for Diagnostic and Interventional Neuroradiology, Medical School Hannover, Hannover, Germany
  
• 刊物主题：Neurosurgery; Interventional Radiology; Neuroradiology; Neurology; Surgical Orthopedics; Minimally Invasive Surgery;
• 出版者：Springer Vienna
• ISSN：0942-0940

文摘

Background Electromagnetic (EM)-guided neuronavigation is an innovative technique and a viable alternative to opto-electric navigation. We have performed a safety and feasibility study using EM-guided neuronavigation for posterior fossa surgery in the semi-sitting position in a selected subset of patients. Methods Out of 284 patients with posterior fossa tumours operated upon over a period of 40?months, a subset of 15 patients was thought to possibly benefit from EM navigational guidance and was included in this study. There were six children and nine adults (aged between 8 and 84?years; mean age, 34.6?years) with different neoplasms in the brainstem or close to the midline. All patients had contrast-enhanced three-dimensional (3D) magnetic resonance imaging (MRI) of the head preoperatively. EM-guided navigation was used to identify and preserve the venous sinuses during craniotomy and to determine the trajectory to the lesion using various approaches. Neuronavigation accuracy was repeatedly checked for deviations measured in millimetres on screen shots during surgery before and after dural opening in the coronal (z-?vertical), axial (x-?mediolateral) and sagittal (y-?anteroposterior) plane. Results Referencing of the patient in the supine position was fast and easy. There was no loss of navigation accuracy after repositioning of the patient in the semi-sitting position (mean, 2.5?mm ± 0.92?mm). Identification of the pathological structure using EM navigation was achieved in all instances. Optimal angulation of the neck was selected individually to permit a comfortable position for the surgeon with full access to the lesion avoiding over-flexion. Deviation of accuracy at the surface of the target lesion ranged between 2.5 and 5.8?mm (mean, 3.9?mm ± 1.1?mm). Conclusions EM-guided neuronavigation in the semi-sitting position was safe and technically feasible. It enabled fast and accurate referencing without loss of navigation accuracy despite repositioning of the patient. In contrast to conventional opto-electric neuronavigation there were no line of sight problems.