Minim Invasive Neurosurg 2009; 52(1): 9-16
DOI: 10.1055/s-0028-1103305
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Minimally Invasive Cerebral Cavernoma Surgery using Keyhole Approaches – Solutions for Technique-related Limitations

A. T. Stadie 1 , R. Reisch 2 , R. A. Kockro 1 , G. Fischer 1 , E. Schwandt 1 , S. Boor 3 , P. Stoeter 3
  • 1Neurochirurgische Klinik und Poliklinik der Johannes Gutenberg-Universität Mainz, Mainz, Germany
  • 2Neurochirurgische Klinik Universitätsspital Zürich, Zürich, Switzerland
  • 3Institut für Neuroradiologie der Johannes Gutenberg-Universität Mainz, Mainz, Germany
Further Information

Publication History

Publication Date:
26 February 2009 (online)

Abstract

Cavernomas are often small in size and located in difficultly accessible regions. Preoperative identification of the ideal surgical approach as well as the precise intraoperative implementation of the surgical plan are of critical importance for successful surgery. While aiming for minimally invasive surgical techniques and maximally effective cavernoma resection, we envisaged that employing a combination of precise and technically sophisticated virtual reality surgery planning, modern navigation systems with augmented reality features and endoscope-assisted surgical techniques should contribute to achieve this goal. Between December 2002 and November 2005, 66 patients were operated on for cerebral cavernomas in our department. In 23 cases surgery planning was done by using a virtual reality planning system, neuronavigation was used in 43 cases and the intraoperative augmented reality feature was used in 16 cases. 10 patients were operated by using the endoscopic assisted surgical technique. Complete resection was achieved in all cases. Using all nowadays available surgical tools, cerebral cavernomas can be operated with minimally invasive techniques and with excellent results.

References

  • 1 Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision.  Neurosurgery. 2005;  57 ((4 Suppl)) 242-255 , discussion 242–255
  • 2 Perneczky A, Mueller-Forell W, Lindert E van. et al .Keyhole concept in neurosurgery with endoscope-assisted microsurgery and case-studies. Stuttgart, New York: Thieme Verlag 1999
  • 3 Perneczky A, Reisch R. Keyhole Approaches in Neurosurgery Volume. 1: Concept and Surgical Technique. Wien, New York: Springer Verlag 2008
  • 4 Kockro RA, Serra L, Tsai YT. et al . Planning of skull base surgery in the virtual workbench: clinical experiences.  Stud Health Technol Inform. 1999;  62 187-188
  • 5 Kockro RA, Serra L, Tseng-Tsai Y. et al . Planning and simulation of neurosurgery in a virtual reality environment.  Neurosurgery. 2000;  46 118-135 , discussion 135–137
  • 6 Serra L, Hern N, Guan CG. et al . An interface for precise and comfortable 3D work with volumetric medical datasets.  Stud Health Technol Inform. 1999;  62 328-334
  • 7 Kockro R, Stadie A, Schwandt E. et al . A collaborative virtual reality environment for neurosurgical planning and training.  Neurosurgery. 2007;  61 ((ONS Suppl)) ONS379-ONS391
  • 8 Stadie A, Kockro R, Reisch R. et al . Virtual reality system for planning minimally invasive neurosurgery.  J Neurosurg. 2008;  108 382-394
  • 9 Grunert P, Charalampaki K, Kassem M. et al . Frame-based and frameless stereotaxy in the localization of cavernous angiomas.  Neurosurg Rev. 2003;  26 53-61
  • 10 Boecher-Schwarz HG, Grunert P, Guenthner M. et al . Stereotactically guided cavernous malformation surgery.  Minim Invasive Neurosurg. 1996;  39 50-55
  • 11 Bertalanffy H, Benes L, Miyazawa T. et al . Cerebral cavernomas in the adult. Review of the literature and analysis of 72 surgically treated patients.  Neurosurg Rev. 2002;  25 1-53 , discussion 54–55
  • 12 Tirakotai W, Sure U, Benes L. et al . Image-guided transsylvian, transinsular approach for insular cavernous angiomas.  Neurosurgery. 2003;  53 1299-1304 , discussion 1304–1305
  • 13 Winkler D, Lindner D, Strauss G. et al . Surgery of cavernous malformations with and without navigational support – a comparative study.  Minim Invas Neurosurg. 2006;  49 15-19
  • 14 Winkler D, Lindner D, Trantakis C. et al . Cavernous malformations – navigational supported surgery.  Minim Invas Neurosurg. 2004;  47 24-28
  • 15 Cinalli G, Cappabianca P, Falco R de. et al . Current state and future development of intracranial neuroendoscopic surgery.  Expert Rev Med Devices. 2005;  2 351-373
  • 16 Gaab MR, Schroeder HW. Neuroendoscopic approach to intraventricular lesions.  J Neurosurg. 1998;  88 496-505
  • 17 Gaab MR, Schroeder HW. Neuroendoscopic approach to intraventricular lesions.  Neurosurg Focus. 1999;  6 e5
  • 18 Bertalanffy H, Kuhn G, Scheremet R. et al . Indications for surgery and prognosis in patients with cerebral cavernous angiomas.  Neurol Med Chir (Tokyo). 1992;  32 659-666
  • 19 Del Curling  Jr  O, Kelly  Jr  DL, Elster AD. et al . An analysis of the natural history of cavernous angiomas.  J Neurosurg. 1991;  75 702-708
  • 20 Robinson JR, Awad IA, Little JR. Natural history of the cavernous angioma.  J Neurosurg. 1991;  75 709-714
  • 21 Kobayashi S. Neurosurgery of Complex Vascular Lesions and Tumors Thieme Medical Publishers. Stuttgart, New York 2005
  • 22 Peters TM. Image-guidance for surgical procedures.  Phys Med Biol. 2006;  51 R505-R540
  • 23 Wurm G, Wies W, Schnizer M. et al . Advanced surgical approach for selective amygdalohippocampectomy through neuronavigation.  Neurosurgery. 2000;  46 1377-1382 , discussion 1382–1383
  • 24 Zotta D, Rienzo A Di, Scogna A. et al . Supratentorial cavernomas in eloquent brain areas: application of neuronavigation and functional MRI in operative planning.  J Neurosurg Sci. 2005;  49 13-19
  • 25 Paleologos TS, Wadley JP, Kitchen ND. et al . Clinical utility and cost-effectiveness of interactive image-guided craniotomy: clinical comparison between conventional and image-guided meningioma surgery.  Neurosurgery. 2000;  47 40-47 , discussion 47–48
  • 26 Resch KD. Postmortem inspection for neurosurgery: a training model for endoscopic dissection technique.  Neurosurg Rev. 2002;  25 79-88
  • 27 Teo C, Nakaji P. Neuro-oncologic applications of endoscopy.  Neurosurg Clin N Am. 2004;  15 89-103
  • 28 Beems T, Grotenhuis JA. Long-term complications and definition of failure of neuroendoscopic procedures.  Childs Nerv Syst. 2004;  20 868-877
  • 29 Teo C, Rahman S, Boop FA. et al . Complications of endoscopic neurosurgery.  Childs Nerv Syst. 1996;  12 248-253 , discussion 253

Correspondence

A. T. StadieMD 

Neurochirurgische Klinik und Poliklinik

Johannes Gutenberg-Universität Mainz

Langenbeckstraße 1

55101 Mainz

Germany

Phone: +49/6131/172 00 6

Fax: +49/6131/172 27 4

Email: stadie@nc.klinik.uni-mainz.de