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At least 307 records · Page 17Linked to original sources

PubMed1999

Computer-assisted resection of cerebral arteriovenous malformations.

OBJECTIVE: A series of 22 patients with arteriovenous malformations (AVMs) were surgically treated using computer-assisted image guidance. The value of image guidance for nidus definition and detection of feeding arteries and draining veins was assessed. METHODS: Seven of the 22 patients presented with hemorrhage. The sizes of the AVMs ranged from 1 to 8 cm. Six patients underwent preoperative embolization. For 18 patients (81.8%), the AVMs were located in highly eloquent areas. A passive-marker-based neuronavigation system (BrainLab, Heimstetten, Germany) was used for intraoperative image guidance. Segmentation of the pathological vessels was performed preoperatively, on the basis of 2-mm helical computed tomographic angiographic slices, to obtain three-dimensional reconstructions of the AVMs. Temporary clips were initially placed on all identifiable feeding arteries, for intranidal pressure reduction before AVM dissection. Dissection of the AVMs was then performed along the main draining veins, as identified by neuronavigation. Patient follow-up monitoring ranged from 3 to 16 months (median, 7 mo). RESULTS: The computer-calculated registration accuracy ranged between 1.1 and 3.1 mm (median, 1.4 mm). Exact nidus definition was possible for all 22 patients. The principal draining veins were also identified for all patients. Feeding arteries could be detected after the segmentation process when the vessels were at least 3 mm in diameter (19 patients). Complete collapse of the AVMs was achieved with initial clip application for 3 patients; partial intranidal pressure reduction was observed for 12 patients. No significant decompression by feeder clipping was possible for pre-embolized AVMs. Perioperative mortality and morbidity rates were 0 and 14%, respectively. CONCLUSION: This image-guided technology allows observation of the relationship between AVMs and adjacent brain structures, increasing spatial orientation during surgery. Definition of an optimal surgical approach and early localization of feeding arteries for temporary occlusion minimize tissue manipulation and enhance the safety of direct dissection along the draining veins, which is necessary in eloquent areas.

Adolescent↗

PubMed2000

Clinical utility and cost-effectiveness of interactive image-guided craniotomy: clinical comparison between conventional and image-guided meningioma surgery.

OBJECTIVE: Although interactive image guidance has been determined to be an increasingly important and reliable tool in contemporary neurosurgery, the clinical results and cost-effectiveness of the use of these systems, compared with conventional techniques, remain understudied. The aim of this study was to investigate the possible benefits of image-guided craniotomies to treat meningiomas, in terms of hospital stays, surgical complications, and, consequently, cost-effectiveness, compared with the results of standard surgery (SS). METHODS: During a 3.5-year period, 100 patients were surgically treated for meningiomas using image-guided surgery (IGS) with neuronavigation assistance and 170 were surgically treated using SS. From the consecutive series of the 100 IGS cases, it was possible to statistically match 50 (in terms of the demographic data, the location and size of the tumor, and the experience of the surgeon) with 50 SS cases. The clinical data were collected prospectively for the IGS group and retrospectively for the SS group. RESULTS: The anesthetic (operation) times were similar for the two groups, although surgical times were shorter for the IGS group (P = 0.02). Blood loss during surgery was less for the IGS group (although not statistically significantly, P > 0.05), but more SS cases required transfusions (P = 0.03). The mean intensive therapy unit stay was 1.7 days for the SS group and 1 day for the IGS group (P = 0.12); the mean hospital stays were 13.5 and 8.5 days, respectively (P = 0.017). Severe complications (permanent or requiring additional surgical procedures) were encountered in 14% of the cases in the SS group and 6% of the cases in the IGS group (P = 0.019), whereas the rates of minor complications (resolved within 30 d without further surgery) were similar (8 and 10%, respectively). The most common problems for the control group were postoperative hematomas (n = 3), which required urgent surgery in two cases; intractable postoperative swelling was treated by lobectomy in another case. In the IGS group, the two severe complications included one case of an infected bone flap and one case of a new permanent neurological deficit. The mean cost per patient was approximately 20% higher for SS than for IGS. CONCLUSION: Although this was not a randomized study, the analysis of these results strongly suggests a positive effect of neuronavigation on the complication rate and thus on intensive care unit and hospital stays, with attendant financial implications.

Adult↗

PubMed2001

Early experiences with image-guided transoral surgery for the pathologies of the upper cervical spine.

STUDY DESIGN: Technical note. OBJECTIVES: Three years of convincing experience with cranial neuronavigation suggested the application of the cranial software and registration method for the transoral access to the C1-C2 vertebrae. BACKGROUND DATA: The C1-C2 vertebrae are located in close vicinity to the cranial base. If the intersegmental movements of the C0-C1/C1-C2 segments are prevented with HALO fixation, the upper cervical spine can be considered as a caudal part of the skull base and included in the extended navigation space of the skull. METHODS: Three patients were selected for navigation-assisted transoral odontoidectomy. Before surgery the patients were fixed and scanned in a HALO device. The fiducials were attached supraorbitally and to both mastoids, determining a wide registration area and allowing the caudal extension of the navigation space. The BrainLAB VectorVision navigation system was used in cranial mode during the operations. RESULTS: Neuronavigation and fluoroscopy-controlled transoral surgery were performed with success in all three cases. The registration accuracy was 1.5, 2.7, and 3.1 mm. CONCLUSION: Image guidance during transoral exposure of the upper cervical spine offered excellent three-dimensional guidance on the ventral surface of the craniocervical junction, allowing a safer, more controlled surgery. As the targets of the transoral spinal surgery are fixed bony and ligamentous structures, no shifting occurs and continuous high navigation accuracy can be achieved. The use of the navigation can reduce the significance of the intraoperative fluoroscopy, diminishing the radiograph load of the patient and the operating room team.

Cervical Vertebrae↗

PubMed2003

Anesthesia during high-field intraoperative magnetic resonance imaging experience with 80 consecutive cases.

Intraoperative magnetic resonance imaging (MRI) has been used for years to update neuronavigation and for intraoperative resection control. For this purpose, low-field (0.1-0.2 T) MR scanners have been installed in the operating room, which, in contrast to machines using higher magnetic field strength, allowed the use of standard anesthetic and surgical equipment. However, these low-field MR systems provided only minor image quality and a limited battery of MR sequences, excluding functional MRI, diffusion-weighted MRI, or MR angiography and spectroscopy. Based on these advantages, a concept using high-field MRI (1.5 T) with intraoperative functional neuronavigational guidance has been developed that required adaptation of the anesthetic regimen to working in the close vicinity to the strong magnetic field. In this paper the authors present their experience with the first 80 consecutive patients who received anesthesia in a specially designed radio frequency-shielded operating room equipped with a high-field (1.5 T) MR scanner. We describe the MR-compatible anesthesia equipment used including ventilator, monitoring, and syringe pumps, which allow standard neuroanesthesia in this new and challenging environment. This equipment provides the use of total intravenous anesthesia with propofol and remifentanil allowing rapid extubation and neurologic examination following surgery. In addition, extended intraoperative monitoring including EEG monitoring required for intracranial surgery is possible. Moreover, problems and dangers related to the effects of the strong magnetic field are discussed.

Adolescent↗

PubMed2002

Surgical removal of brain stem cavernous malformations: surgical indications, technical considerations, and results.

OBJECTIVES: This study was undertaken to review the indications for surgical treatment of brain stem cavernomas and to develop strategies to minimise the complications of surgery. PATIENTS AND RESULTS: Twelve patients underwent surgical resection of a brain stem cavernoma due to symptoms caused by one or more haemorrhages. Age ranged from 18 to 47 years (mean 29.2 years). Long term follow up (mean 3.7 years) included a complete neurological examination and annual MRI studies. The annual haemorrhage rate was 6.8 %/patient/year and a rate of 1.9 rehaemorrhages/patient/year was found. Surgery was performed under microsurgical conditions with endoscopic assistance, use of neuronavigation, and neurophysiological monitoring. Navigation proved to be reliable when applied in an early stage of operative procedure with minimal brain retraction. Endoscopy was a useful tool in some cases to confirm complete resection of the lesion and to ascertain haemostasis. Ten patients had a new neurological deficit in the early postoperative period, nine of these were transient. At the last follow up the neurological state was improved in five patients, unchanged in six, and worse in one compared with the preoperative conditions. The preoperative average Rankin score was 2.2 points and had improved at the last follow up by 0.6 points to 1.6 points. CONCLUSIONS: Symptomatic brain stem cavernomas should be considered for surgical treatment after the first bleeding. Careful selection of the optimal operative approach and a meticulous microsurgical technique are mandatory. The additional use of modern tools such as neuronavigation, endoscopic assistance, and monitoring can contribute to the safety of the procedure.

Adolescent↗

PubMed2005

Benefits of adapting minimal invasive techniques to selected patients with spontaneous supratentorial intracerebral hematomas.

OBJECTIVES: This study assesses the benefits of adapting minimal invasive techniques (MIT) to selected patients with spontaneous supratentorial intracerebral hematomas (SSICHs). METHODS: The study compares the post-operative residual clot volume and clinical outcome of 89 selected, MIT evacuated SSICH-patients to those of 138 unselected cases operated in our department. Selection criteria includes patient age, early admission and MIT treatment. MIT treatment included: 28 patients with deep SSICHs smaller than 30 cm3 associated with intraventricular bleeding who underwent neuronavigation-guided stereotactic catheter lysis, 37 patients with deep hematomas larger than 30 cm3 and 24 patients with a lobar hemorrhage compressing eloquent regions who underwent microsurgical (endoscopic or neuronavigation assisted) clot aspiration. RESULTS: In eight (9%) of the patients in the MIT group, the CT scan control showed a residual clot smaller than 30% of the initial hemorrhage. The neurological condition 3 months later revealed 24 (26.9%) of these patients having a severe disability and 46 (51.6%) patients independent or slightly disabled. Nineteen patients (21.9%) died or remained vegetative. In the control group, 48 (34.7%) cases showed residual clots (<30%). Sixty-two (44.9%) patients of this group were severely disabled and only 40 (28.9%) were independent. Thirty-six (26%) patients died or were vegetative. There was a p<0.001 significant difference in volume of residual clots as well as p<0.01 for the outcome between the two groups. CONCLUSIONS: Adapting minimally invasive techniques to case selection improves the effectiveness of clot removal and the outcome of the patients with SSICHs.

Adolescent↗

PubMed2003

Anesthesia management for spine surgery using spinal navigation in combination with computed tomography.

The development of a spine surgery using neuronavigation with intraoperative computed tomography (CT) is of benefit to the patient. However, the procedure also has a major impact on anesthesia management. During the procedure, the patient remains in the prone position on the CT examination table and is moved extensively during CT scans. Furthermore, there is inadequate separation between operating field and anesthetic area. Problems encountered during the procedure were patient positioning, limited patient access, long tubing, and therefore the need for adequate monitoring. We report our experience using this approach in 35 patients with spinal fracture, spinal degeneration, and tumor and describe a step-by-step anesthetic management protocol that has been developed as a guideline for use in spinal neuronavigation with intraoperative CT at our center.

Adolescent↗

PubMed2006

Augmentation of anterior lumbar interbody fusion with anterior pedicle screw fixation: demonstration of novel constructs and evaluation of biomechanical stability in cadaveric specimens.

OBJECTIVE: Anterior lumbar interbody fusion (ALIF) has proven effective for indications including discogenic back pain, nonunion, and instability. Current practice involves posterior pedicle screw augmentation of the ALIF procedure (ALIF-PPS). This approach requires intraoperative repositioning of the patient for percutaneous posterior pedicle screw placement. We have developed a novel technique in which the ALIF procedure is augmented with anterior pedicle screws (APS; ALIF-APS). In this study, we introduce this new technique and compare the biomechanical stability of the novel ALIF-APS with the current standard ALIF-PPS. METHODS: The technique was demonstrated in a cadaveric L4-S1 specimen using neuronavigation and fluoroscopy. Plain radiographs and computed tomographic scans of the construct were obtained. Twelve cadaveric spines (7 men and 5 women) from donors with an average age of 81 years (range, 64-93 yr) were then harvested from L4-S1. Six specimens were dedicated to ALIF-APS constructs, and the remaining six were dedicated to ALIF-PPS constructs. The specimens were then studied at L5-S1 in the following steps: 1) intact form, 2) after anterior discectomy, 3) after implantation of titanium cages (ALIF), and 4) after APS or PPS fixation in conjunction with the ALIF. Measurements were obtained in axial rotation and left and right lateral bending flexion-extension. Data were normalized by calculating the ratio of the stiffness of the instrumented to the intact spine. Statistical analyses were then performed on the data. RESULTS: Radiographs and computed tomographic scans of the construct showed accurate placement of the APS at L5 and S1. The normalized data showed that ALIF-APS and ALIF-PPS had approximately equal stability in axial rotation (1.17 +/- 0.43 versus 0.85 +/- 0.14), lateral bending (0.93 +/- 0.22 versus 0.95 +/- 0.16), and flexion- extension (0.77 +/- 0.13 versus 0.84 +/- 0.2). Paired t test analysis did not show a significant difference between the biomechanical stiffness of ALIF-APS and ALIF-PPS in axial rotation, lateral bending, and flexion-extension. CONCLUSION: We demonstrate a new technique in a cadaveric specimen whereby the ALIF procedure is augmented with APS fixation using neuronavigation and fluoroscopy. Biomechanical evaluation of the constructs suggests that the ALIF-APS has comparable stability with ALIF-PPS. APS augmentation of ALIF has potential advantages over the current standard ALIF-PPS because it can 1) eliminate the patient repositioning step, 2) minimize the total number of incisions and the total operative time, and 3) protect against dislocation of the ALIF interbody graft or cage. Work is in progress to develop a low-profile system for the novel APS constructs described here.

Aged↗

PubMed2000

Intraventricular aneurysms--three case reports.

Three rare cases of purely intraventricular aneurysms are described, including a unique aneurysm in the fourth ventricle. A 30-year-old female, a 47-year-old male, and an 11-year-old girl presented with disturbance of consciousness due to massive intraventricular hemorrhage. Digital subtraction angiography revealed an idiopathic peripheral aneurysm in the fourth ventricle in the first patient, and aneurysms in the lateral ventricle associated with moyamoya disease in the latter two patients. The former two aneurysms were treated surgically and histologically confirmed to be pseudoaneurysms. The latter aneurysm disappeared spontaneously within 2 months after onset. The aneurysm in the lateral ventricle was resected via a parietal corticotomy with stereotactic insertion of an 8-Fr silicone tube to guide the approach route. This method was very useful because computerized neuronavigation was not available. The aneurysm in the fourth ventricle was resected via a midline suboccipital approach with C-1 laminectomy. Conservative treatment is usually recommended initially for patients with intraventricular aneurysm because spontaneous cure often occurs. We recommend direct surgery if the size of the aneurysm remains unchanged, because the risk of surgery has decreased recently owing to new techniques for neuronavigation.

Adult↗

PubMed2006

Comparative analysis of diagnostic accuracy of different brain biopsy procedures.

BACKGROUND: Image-guided procedures such as computed tomography (CT) guided, neuronavigator-guided and ultrasound-guided methods can assist neurosurgeons in localizing the intraparenchymal lesion of the brain. However, despite improvements in the imaging techniques, an accurate diagnosis of intrinsic lesion requires tissue sampling and histological verification. AIMS: The present study was carried out to examine the reliability of the diagnoses made on tumor sample obtained via different stereotactic and ultrasound-guided brain biopsy procedures. MATERIALS AND METHODS: A retrospective analysis was conducted of all brain biopsies (frame-based and frameless stereotactic and ultrasound-guided) performed in a single tertiary care neurosciences center between 1995 and 2005. The overall diagnostic accuracy achieved on histopathology and correlation with type of biopsy technique was evaluated. RESULTS: A total of 130 cases were included, which consisted of 82 males and 48 females. Age ranged from 4 to 75 years (mean age 39.5 years). Twenty per cent (27 patients) were in the pediatric age group, while 12% (16 patients) were >or= 60-years of age. A definitive histological diagnosis was established in 109 cases (diagnostic yield 80.2%), which encompassed 101 neoplastic and eight nonneoplastic lesions. Frame-based, frameless stereotactic and ultrasound-guided biopsies were done in 95, 15 and 20 patients respectively. Although the numbers of cases were small there was trend for better yield with frameless image-guided stereotactic biopsy and maximum diagnostic yield was obtained i.e, 87% (13/15) in comparison to conventional frame-based CT-guided stereotactic biopsy and ultrasound-guided biopsy. CONCLUSIONS: Overall, a trend of higher diagnostic yield was seen in cases with frameless image-guided stereotactic biopsy. Thus, this small series confirms that frameless neuronavigator-guided stereotactic procedures represent the lesion sufficiently in order to make histopathologic diagnosis.

Adolescent↗

PubMed1999

Intraoperative MR imaging increases the extent of tumor resection in patients with high-grade gliomas.

BACKGROUND AND PURPOSE: MR is being used increasingly as an intraoperative imaging technique. The purpose of this study was to test the hypothesis that intraoperative MR imaging increases the extent of tumor resection, thus improving surgical results in patients with high-grade gliomas. METHODS: Thirty-eight patients with intracranial high-grade gliomas underwent 41 operations. Using a neuronavigation system, tumors were resected in all patients to the point at which the neurosurgeon would have terminated the operation because he thought that all enhancing tumor had been removed. Intraoperative MR imaging (0.2 T) was performed, and surgery, if necessary and feasible, was continued. All patients underwent early postoperative MR imaging (1.5 T). By comparing the proportions of patients in whom complete resection of all enhancing tumor was shown by intraoperative and early postoperative MR imaging, respectively, the impact of intraoperative MR imaging on surgery was determined. RESULTS: Intraoperative MR imaging showed residual enhancing tumor in 22 cases (53.7%). In 15 patients (36.6%), no residual tumor was seen, whereas the results of the remaining four intraoperative MR examinations (9.7%) were inconclusive. In 17 of the 22 cases in which residual tumor was seen, surgery was continued. Early postoperative MR imaging showed residual tumor in eight patients (19.5%) and no residual tumor in 31 cases (75.6%); findings were uncertain in two patients (4.9%). The difference in the proportion of "complete removals" was statistically highly significant (P = .0004). CONCLUSION: Intraoperative MR imaging significantly increases the rate of complete tumor removal. The rate of complete removal of all enhancing tumor parts was only 36.6% when neuronavigation alone was used, which suggests the benefits of intraoperative imaging.

Adult↗

PubMed1999

Pre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases.

Operative neurosurgery has recently entered an exciting era of image guided surgery or neuronavigation and application of this novel technology is beginning to have a significant impact in many ways in a variety of intracranial procedures. In order to fully assess the advantages of image guided techniques over conventional planning and surgery in selected cases, detailed prospective evaluation has been carried out during the advanced development of an optically tracked neuronavigation system. Over a 2-year period, 300 operative neurosurgical procedures have been performed with the assistance of interactive image guidance, as well as the development of new software applications and hardware tools. A broad range of intracranial neurosurgical procedures were seen to benefit from image guidance, including 163 craniotomies, 53 interactive stereotactic biopsies, 7 tracked neuroendoscopies and 37 complex skull base procedures. The most common pathological diagnoses were cerebral glioma in 98 cases, meningioma in 64 and metastasis in 23. Detailed analysis of a battery of postoperative questions revealed benefits in operative planning, appreciation of anatomy, lesion location, safety of surgery and greatly enhanced surgical confidence. The authors believe that image guided surgical technology, with new developments such as those described, has a significant role to play in contemporary neurosurgery and its widespread adoption in practice will be realised in the near future.

Adolescent↗

PubMed2001

[Clinical evaluation of frameless stereotaxy in minimally invasive neurosurgery].

OBJECTIVE: To evaluate the utility of frameless stereotaxy in minimally invasive neurosurgery. METHODS: A retrospective review of 200 cases of craniotomy and laminotomy procedures using frameless stereotaxy systems performed from December 1999 to June 2001 was made, including 43 cases of AVM, 39 cases of aneurysm, 30 of meningioma, 27 of cavenous malformation, 19 of glioma, 8 of neuronoma, 5 of pituitary tumor, 4 of angioreticuloma, 3 of metastatic tumor, 14 cases of craniotomy with other causes, and 8 spinal tumors. Data of MRI or CT, conducted one day before the operation, were entered into the neuronavigation systems and analyzed. A 3-D simulation of model of cranium or spinal cord was reestablished and operative approach was designed. During the operation, the lesion can be located accurately. RESULTS: The lesions and important anatomical structures were accurately located and the location errors of lesions were within the limit of 2 mm. Postoperative neurological complications occurred only in 10 cases (5.0%). No operative death occurred. CONCLUSION: The frameless stereotaxy is very helpful for brain and spinal surgery, especially for the cases with lesions located deep in the brain. Its accuracy of location is very important in protecting normal brain tissues. The neuronavigation systems are changing the pattern of traditional neurosurgical procedures and serve as the guarantee of minimally invasive neurosurgery.

Humans↗

PubMed2001

[Microsurgery of brainstem cavernous malformation].

OBJECTIVE: To evaluate the effectiveness and benefits of surgical treatment of cavernous malformations (CMs) in brainstem. METHODS: From 1992 to 1999, 7 cases of brainstem cavernous malformations (six females and one male, aged 44 on average) with 6 lesions in pons, one in mesencephalon, and one in medulla oblongata, were operated on with microsurgery. In the recent three years neuronavigation system has been applied. RESULTS: All of the eight lesions were removed without death toll. The functional disorders of nervous system were improved after operation in four cases. The neurological deficits worsened in two cases, however, their neurological functions improved gradually to the preoperative level in four months or three years. The neurological function in the case with lesion in mesencephalon worsened after operation. Pathology revealed a grade one oligodendroglioma in addition to the CM lesion. Neuronavigation helped facilitate the accurate location of the lesions and minimize the surgical injury. CONCLUSION: Microsurgery is effective in treating brainstem cavernous malformations with appropriate indications and minimal invasive technique.

Adult↗

PubMed2002

[Image-guided neuroendoscopy].

BACKGROUND AND PURPOSE: By definition, image-guided neuroendoscopy is a connection between a neuroendoscope and a neuronavigational system creating a computer-guided instrument. Our objective was to adapt our rigid endoscope with our neuronavigation system to perform computer-guided endoscopy. METHODS AND RESULTS: The rigid neuroendoscope, equipped with light emitting diodes, was connected to the work station. We report our early results with this device in 17 patients: 8 ventriculocisternostomies, 5 ventriculocisternostomies with biopsies of tumors of the posterior part of the third ventricule, 4 biopsies or tumor removal like colloid cysts. No technical complications were encountered. CONCLUSIONS: The development of image-guided neuroendoscopy has modified our approach to neuroendoscopy because the surgical procedure is facilitated. The use of fluoroscopy becomes unnecessary. The surgeon can choose, independent of the preestablish surgical technique, the entry point, the target and, of course, the optimal trajectory. The technique is adaptable to the individual anatomy of each patient, the location and the nature of the target. It is an undeniably useful teaching tool and represents a real progress in minimally invasive neurosurgery.

Adult↗

PubMed2003

Mixed reality for neurosurgery: a novel prototype.

Microscopes and neuronavigators are often used in neurosurgical procedures. Our Mixed Reality prototype proposes to show neuronavigator imaging overlayed onto the surgical field of view. The proposal is to replace the traditional optical microscope with a digital one. The system is presented in this article. Firsts trials have been performed at the laboratory with satisfactory results.

Computer Simulation↗

PubMed2005

[Image-guided endoscopic transsphenoidal removal of pituitary adenoma].

OBJECTIVE: To assess the role of neuronavigation in assisting endoscopic transsphenoidal surgery for pituitary adenomas. METHODS: Ten endoscopic endonasal transsphenoidal reoperations for pituitary adenomas were selected. Clinical records were reviewed retrospectively. Five of 10 patients had gigantic adenoma, 3 microadenoma, 2 large adenoma. RESULTS: The mean setup time was 5 minutes, and the operative time was 50 minutes in image-guided procedures. In all cases, the system worked well without malfunction. Continuous information regarding instrument location and trajectory was provided to the surgeon. Measurements of intraoperative accuracy in the axial, coronal, and.sagittal planes indicated a mean verified system error of 1.5 mm. for pituitary adenomas. After operation, the symptoms relieved in all patients. CONCLUSIONS: Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and safer.

Adult↗

PubMed2005

[Endoscopic endonasal surgery for tumors of petroclival region and infratemporal fossa].

OBJECTIVE: Nasal endoscope has been used increasingly during skull base surgery. However, most of endoscopic surgery limited to the repair of cerebrospinal rhinorrhea, decompression of traumatic optic nerve, hypophysectomy, etc. This study was undertaken to determine whether endoscopic endonasal approach was safe and effective for the resection of tumors located in petroclival region and infratemporal fossa. METHODS: Seventeen patients with tumors of petroclival region and infratemporal fossa treated by endoscopic endonasal surgery between January 2002 and February 2005 were studied prospectively. The operative technique was described in detail. There were 5 chordoma, 1 esthesioneuroblastoma, 1 chondrosarcoma, 1 lymphoma, 1 craniopharyngioma, 1 hemangioblastoma, 4 meningioma, 1 schwannoma, and 2 metastatic carcinoma. 3 patients were selected for neuronavigation-aided endoscopic endonasal surgery. RESULTS: Total tumor removal was obtained in 15 cases, subtotal removal in 2 case. With follow-up of 5 to 43 months, 1 case with chordoma was recurrent 5 months later postoperatively and underwent reoperation subsequently. The other cases with benign tumors were no recurrence. All of 5 cases with malignant tumors followed up for longer than 2 years were no recurrence and death. The complications included subarachnoid hemorrhage in 1 patient, transient cerebrospinal leakage in 2 cases. CONCLUSIONS: The endoscopic endonasal surgery provides satisfied treatment for selected tumors of petroclival region and infratemporal fossa. This approach promises a simple and rapid access to petroclival region and infratemporal fossa. It is a safe, minimally invasive and efficient procedure. Using neuronavigation system, it is helpful to determining anatomical landmark and removing the tumor completely and securely.

Adult↗