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DOI: 10.1055/s-2003-39338
Image-Guided Removal of Supratentorial Cavernomas in Critical Brain Areas: Application of Neuronavigation and Intraoperative Magnetic Resonance Imaging
Publication History
Publication Date:
22 May 2003 (online)
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Abstract
In a retrospective study the postoperative results of 26 patients operated on for supratentorial cavernous hemangiomas either deep-seated or near eloquent brain areas are summarized. An exact surgical approach to these lesions is essential to prevent neurological deterioration. Three different navigation systems were used and compared according to their clinical applicability. Complete removal of the lesion was obtained in all patients of this series. In six cases (23 %) functional data from magnetoencephalography or functional magnetic resonance imaging were integrated into the navigational setup. In 14 cases (54 %) intraoperative magnetic resonance imaging was performed. The follow-up time was 3 - 26 months (mean: 10 months). In the postoperative course one patient (3.8 %) developed a hemiparesis, another one developed quadrantopia. Nineteen patients presented with preoperative seizure history, 16 of these (84 %) had no further or rare seizures after surgery. The better results in seizure control were achieved in those patients with shorter duration of seizure history before surgery. The study indicates that the application of neuronavigation allows surgery on supratentorial cavernous hemangiomas in critical brain areas with low morbidity. The intraoperative visualization of eloquent cortex areas by integration of functional data allows a fast identification and exemption of eloquent brain areas, preventing neurological deterioration. Furthermore, the intraoperative MR resection control ensures a complete resection and illustrates the minimal invasive approach.
Key words
Cavernoma - intraoperative magnetic resonance imaging - functional neuronavigation - seizure control
References
- 1 Simard J M, Garcia-Bengochea F, Ballinger Jr W E, Mickle J P, Quisling R G. Cavernous angioma: a review of 126 collected and 12 new clinical cases. Neurosurgery. 1986; 18 162-172
- 2 Otten P, Pizzolato G P, Rilliet B, Berney J. 131 cases of cavernous angioma (cavernomas) of the CNS, discovered by retrospective analysis of 24,535 autopsies. Neurochirurgie. 1989; 35 82-83
- 3 Robinson J R, Awad I A, Little J R. Natural history of the cavernous angioma. J Neurosurg. 1991; 75 709-714
- 4 Del Curling Jr O, Kelly Jr D L, Elster A D, Craven T E. An analysis of the natural history of cavernous angiomas. J Neurosurg. 1991; 75 702-708
- 5 Lobato R D, Perez C, Rivas J J, Cordobes F. Clinical, radiological, and pathological spectrum of angiographically occult intracranial vascular malformations. Analysis of 21 cases and review of the literature. J Neurosurg. 1988; 68 518-531
- 6 Casazza M, Broggi G, Franzini A, Avanzini G, Spreafico R, Bracchi M, Valentini M C. Supratentorial cavernous angiomas and epileptic seizures: preoperative course and postoperative outcome. Neurosurgery. 1996; 39 26-32
- 7 Nimsky C, Ganslandt O, Hastreiter P, Fahlbusch R. Intraoperative compensation for brain shift. Surg Neurol. 2001; 56 357-364
- 8 Nimsky C, Ganslandt O, Kober H, Moller M, Ulmer S, Tomandl B, Fahlbusch R. Integration of functional magnetic resonance imaging supported by magnetoencephalography in functional neuronavigation. Neurosurgery. 1999; 44 1249-1255
- 9 Ganslandt O, Fahlbusch R, Nimsky C, Kober H, Moller M, Steinmeier R, Romstock J, Vieth J. Functional neuronavigation with magnetoencephalography: outcome in 50 patients with lesions around the motor cortex. J Neurosurg. 1999; 91 73-79
- 10 Gunkel A R, Freysinger W, Thumfart W F. Experience with various 3-dimensional navigation systems in head and neck surgery. Arch Otolaryngol Head Neck Surg. 2000; 126 390-395
- 11 Kiya N, Dureza C, Fukushima T, Maroon J C. Computer navigational microscope for minimally invasive neurosurgery. Minim Invasive Neurosurg. 1997; 40 110-115
- 12 Roessler K, Ungersboeck K, Dietrich W, Aichholzer M, Hittmeir K, Matula C, Czech T, Koos W T. Frameless stereotactic guided neurosurgery: clinical experience with an infrared based pointer device navigation system. Acta Neurochir. 1997; 139 551-559
- 13 Kober H, Moller M, Nimsky C, Vieth J, Fahlbusch R, Ganslandt O. New approach to localize speech relevant brain areas and hemispheric dominance using spatially filtered magnetoencephalography. Hum Brain Mapp. 2001; 14 236-250
- 14 Kober H, Grummich P, Vieth J. Precise fusion of MEG and MRI tomography using a surface fit. Biomedical Engineering (Berlin). 1993; 38 (Suppl.) 197-198
- 15 Nimsky C, Ganslandt O, Kober H, Buchfelder M, Fahlbusch R. Intraoperative magnetic resonance imaging combined with neuronavigation: a new concept. Neurosurgery. 2001; 48 1082-1089
- 16 Vickrey B G, Hays R D, Engel Jr J, Spritzer K, Rogers W H, Rausch R, Graber J, Brook R H. Outcome assessment for epilepsy surgery: the impact of measuring health-related quality of life. Ann Neurol. 1995; 37 158-166
- 17 Moran N F, Fish D R, Kitchen N, Shorvon S, Kendall B E, Stevens J M. Supratentorial cavernous haemangiomas and epilepsy: a review of the literature and case series. J Neurol Neurosurg Psychiatry. 1999; 66 561-568
- 18 Frima-Verhoeven P A, Op de Coul A A, Tijssen C C, Maat B. Intracranial cavernous angiomas: diagnosis and therapy. Eur Neurol. 1989; 29 56-60
- 19 Seifert V, Trost H A, Dietz H. Cavernous angiomas of the supratentorial compartment. Zentralbl Neurochir. 1989; 50 89-92
- 20 Zevgaridis D, van Velthoven V, Ebeling U, Reulen H J. Seizure control following surgery in supratentorial cavernous malformations: a retrospective study in 77 patients. Acta Neurochir. 1996; 138 672-677
- 21 Cohen D S, Zubay G P, Goodman R R. Seizure outcome after lesionectomy for cavernous malformations. J Neurosurg. 1995; 83 237-242
- 22 Churchyard A, Khangure M, Grainger K. Cerebral cavernous angioma: a potentially benign condition? Successful treatment in 16 cases. J Neurol Neurosurg Psychiatry. 1992; 55 1040-1045
- 23 Yeh H S, Tew J M, Gartner Jr M. Seizure control after surgery on cerebral arteriovenous malformations. J Neurosurg. 1993; 78 12-18
- 24 Wyllie E, Luders H, Morris 3rd H H, Lesser R P, Dinner D S, Hahn J, Estes M L, Rothner A D, Erenberg G, Cruse R. et al . Clinical outcome after complete or partial cortical resection for intractable epilepsy. Neurology. 1987; 37 1634-1641
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