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Results for “Neuronavigation”

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At least 433 records · Page 24Linked to original sources

PubMed1998

Frameless stereotactic-directed tissue sampling during surgery of suspected low-grade gliomas to avoid histological undergrading.

Detection of anaplastic tumor foci for precise grading of gliomas is crucial for prognostic assessment and appropriate postoperative treatment planning. To avoided undergrading in large suspected low-grade gliomas, we employed frameless sterotaxy during open surgery for tissue sampling of radiologically suspected anaplastic foci. In nine patients (mean age 44 years, range 10-67) with large supratentorial suspected low-grade gliomas (32.4 ccm mean vol, range 17.9-68.6 ccm) with small contrast enhancing areas (7.7% mean of total volume, range 0.7-15.3%), a neuronavigation system with a pointer device (Easy Guide System Philips) or a navigating microscope (MKM System Zeiss) was used to target small enhancing tumor parts for cytological investigation during open surgery. Consecutive cytological smears revealed anaplastic tumor foci in all patients, correlating with neuroradiologically demonstrated small contrast enhancing areas, although biopsies from all other tumor parts showed low-grade tumors. Final neuropathological diagnosis confirmed anaplasia within the neuroradiologically suspected low-grade gliomas in all patients (2 grade IV, 5 WHO grade III and 2 grade II-III tumors, WHO classification). In our experience frameless stereotactic-directed intraoperative tissue sampling during open surgery of large suspected low-grade gliomas helps to identify small anaplastic areas in mostly large low-grade tumors, and therefore, permits optimum planning of postoperative treatment.

Adolescent↗

PubMed1996

MRI-guided endoscopy in the brain: a feasability study.

For neuronavigation in neuroendoscopy conventional navigation systems cannot exclude tissue movements caused by loss of cerebrospinal fluid (CSF). Open MRI can serve as a real-time navigation system if special conditions of endoscopic instruments and equipment are followed. We adapted an endoscopic system to the MRI and installed a miniaturized laser guidance system to project the central transaxial and coronal planes onto the phantom. A human cadaveric model was examined with a flexible microendoscope marked with a titanium wire inside the open magnet. The procedures were guided by gradient echo sequences refreshing the image every 4.5 seconds to control position of the endoscope. Endoscopic and corresponding MRI-findings are presented. Results and technical conditions are discussed.

Artifacts↗

PubMed2005

Spinous process marking: a reliable method for preoperative surface localization of intradural lesions of the high thoracic spine.

Surgical exposure of intradural lesions in the thoracic spine requires intraoperative landmarks to identify the vertebral level. If spinal neuronavigation is not available, the surgeon must rely on alternative localizing methods. Intraoperative fluoroscopy is traditionally used to count the vertebrae throughout the whole spine. In the high thoracic spine, counting the vertebrae is often hampered by the scapular shadows. In these cases, a preoperative marking procedure seems preferable. Magnetic resonance imaging (MRI) based techniques have been increasingly reported, but they share an intrinsic risk of error due to the skin shift occurring at the time of surgery. We describe here a simple technique for unequivocal identification of the vertebral target. In six patients undergoing surgery for intradural lesions of the high thoracic spine, the spinous process of the vertebra corresponding to the lesion was preoperatively identified on an anteroposterior radiograph view and marked infiltrating its tip with a blue dye. At surgery, the vertebral target was identified easily and immediately. No errors occurred. No complications related to the technique were observed. Preoperative marking of the vertebral spinous process with a coloured dye is a simple and unequivocal guide to expose intradural lesions in the high thoracic spine.

Coloring Agents↗

PubMed1999

Computer-guided laser probe for ablation of brain tumours with ultrashort laser pulses.

A computer-guided laser probe has been developed for the application of ultrashort-pulsed lasers in neurosurgery. It is part of a novel operation concept for the treatment of deep-seated brain tumours. The system combines the positioning accuracy of stereotactic or neuronavigated instruments with the precise and therefore gentle characteristics of surgical lasers. The probe has an outer diameter of 5.5 mm and is directly inserted into the target volume. By a synchronized movement of three coaxial tubes, which guide the embedded optics, the laser radiation is focused at any time onto the current tissue surface. Since every single laser pulse has only a small effective volume of about 8 x 10(5) microm3, the application of a large number of succeeding pulses can be adapted to required geometries. Tissue fragments are removed from the growing operation cavity by continuous irrigation and suction through the laser probe. Blood vessels are detected by a confocal laser-scanning microscope, which is integrated into the probe, and can be closed by an additional coagulating laser. In this paper, the design and technical properties of the laser probe as well as its use in ablation and coagulation experiments are presented. A description of the overall operation system is given.

Animals↗

PubMed2005

O-(2-[18F]fluoroethyl)-L-tyrosine PET combined with MRI improves the diagnostic assessment of cerebral gliomas.

MRI is commonly used to determine the location and extent of cerebral gliomas. We investigated whether the diagnostic accuracy of MRI could be improved by the additional use of PET with the amino acid O-(2-[18F]fluoroethyl)-l-tyrosine (FET). In a prospective study, PET with FET and MRI was performed in 31 patients with suspected cerebral gliomas. PET and MRIs were co-registered and 52 neuronavigated tissue biopsies were taken from lesions with both abnormal MRI signal and increased FET uptake (match), as well as from areas with abnormal MR signal but normal FET uptake or vice versa (mismatch). Biopsy sites were labelled by intracerebral titanium pellets. The diagnostic performance for the identification of cellular tumour tissue was analysed for either MRI alone or MRI combined with FET PET using alternative free response receiver operating characteristic curves (ROCs). Histologically, 26 biopsy samples corresponded to cellular glioma tissue and 26 to peritumoral brain tissue. The diagnostic performance, as determined by the area under the ROC curve (Az), was Az = 0.80 for MRI alone and Az = 0.98 for the combined MRI and FET PET approach (P < 0.001). MRI yielded a sensitivity of 96% for the detection of tumour tissue but a specificity of only 53%, and combined use of MRI and FET PET yielded a sensitivity of 93% and a specificity of 94%. Combined use of MRI and FET PET in patients with cerebral gliomas significantly improves the identification of cellular glioma tissue and allows definite histological tumour diagnosis. Thus, our findings may have considerable impact on target selection for diagnostic biopsies as well as therapy planning.

Adolescent↗

PubMed1993

Surgery of supratentorial tumors.

Neurosurgery may be the ultimate treatment of benign tumors, eg, certain meningiomas and acoustic neurinomas; however, for invasive and malignant tumors, it is just another part in a multimodality approach coupled with radiotherapy, chemotherapy, and possibly immunotherapy. Still heading for more efficiency, new surgical techniques and aids have been developed. Their multiplicity and precision should encourage the neurosurgeon to even more carefully plan the type of surgery by a thorough preoperative evaluation. Preoperative management now not only assesses the size and the extent of the tumor but tries to find hints of its degree of malignancy to understand the perilesional edema and to guide the surgeon's hand. Although surgical approaches have been improved over the past years by the introduction of microsurgery, the ultrasonic aspirator, laser, and perioperative ultrasound, computer-assisted stereotactic neuronavigation seems to be the major novelty, and its future developments may prove to be of great medical value. Finally, the postoperative evaluation of the patient also benefits from new standards in neuroimaging and radionuclide investigations, allowing better estimation of residual tumor and early diagnosis of recurrence.

Adult↗

PubMed2000

Intraoperative magnetic resonance imaging.

Intraoperative magnetic resonance imaging (MRI) allows neurosurgeons to perform surgery interactively using magnetic resonance (MR) guidance. Low-field and high-field strength MRI has been developed and implemented for multiple neurosurgical procedures, including brain biopsies, craniotomies for resection of mass lesions, cyst drainages, laminectomies, thermal ablations, functional neurosurgery, and a variety of miscellaneous cases. Both technologies have the advantage over frameless neuronavigational systems of being able to perform near real-time imaging, which allows the surgeon to compensate for intraoperative brain shift. Intraoperative functional techniques such as MR spectroscopy, functional MRI, MR angiography and venography, and diffusion-weighted imaging, which have become routine at some high-field MR units, can significantly influence surgical decision making. The potential complications associated with intraoperative MR-guided neurosurgery are similar in incidence to those seen in the conventional neurosurgical operating room. However, the immediate recognition of such intraoperative complications with MRI should lead to improved outcomes and decreased medical costs. Untoward events associated with performing surgery in an MR environment are uncommon. Intraoperative MR-guided neurosurgery represents a natural progression from framed and frameless stereotactic techniques. Intraoperative MRI is still in its infancy, and the full capabilities of this technology have yet to be determined or implemented.

Humans↗

PubMed1997

Magnetic source imaging combined with image-guided frameless stereotaxy: a new method in surgery around the motor strip.

OBJECTIVE: In this study, information about the localization of the central sulcus obtained by magnetic source imaging (MSI) was intraoperatively translated to the brain, using frameless image-guided stereotaxy. In the past, the MSI results could be translated to the surgical space only by indirect methods (e.g., the comparison of the MSI results, displayed in surface renderings, with bony landmarks or blood vessels on the exposed brain surface). METHODS: Somatosensory evoked fields were recorded with a MAGNES II biomagnetometer (Biomagnetic Technologies Inc., San Diego, CA). Using the single equivalent current dipole model, the localization of the somatosensory cortex was superimposed on magnetic resonance imaging with a self-developed contour fit program. The magnetic resonance image set containing the magnetoencephalographic dipole was then transferred to a frameless image-guided stereotactic system. Intraoperatively, the gyrus containing the dipole was identified as the postcentral gyrus, using neuronavigation, and the next anterior sulcus was regarded as the central sulcus. With intraoperative cortical recording of somatosensory evoked potentials, this assumption was verified in each case. RESULTS: In all cases, the preoperatively assumed localization of the central sulcus and motor cortex with MSI agreed with the intraoperative identification of the central sulcus using the phase reversal technique. CONCLUSION: The combined use of MSI and a frameless stereotactic system allows a fast orientation of eloquent brain areas during surgery. This may contribute to a safer and more radical surgery in lesions adjacent to the motor cortex.

Aged↗

PubMed1998

Intraoperative magnetic resonance imaging with the magnetom open scanner: concepts, neurosurgical indications, and procedures: a preliminary report.

OBJECTIVE: Intraoperative magnetic resonance imaging (MRI) is now available with the General Electric MRI system for dedicated intraoperative use. Alternatively, non-dedicated MRI systems require fewer specific adaptations of instrumentation and surgical techniques. In this report, clinical experiences with such a system are presented. METHODS: All patients were surgically treated in a "twin operating theater," consisting of a conventional operating theater with complete neuronavigation equipment (StealthStation and MKM), which allowed surgery with magnetically incompatible instruments, conventional instrumentation and operating microscope, and a radiofrequency-shielded operating room designed for use with an intraoperative MRI scanner (Magnetom Open; Siemens AG, Erlangen, Germany). The Magnetom Open is a 0.2-T MRI scanner with a resistive magnet and specific adaptations that are necessary to integrate the scanner into the surgical environment. The operating theaters lie close together, and patients can be intraoperatively transported from one room to the other. This retrospective analysis includes 55 patients with cerebral lesions, all of whom were surgically treated between March 1996 and September 1997. RESULTS: Thirty-one patients with supratentorial tumors were surgically treated (with navigational guidance) in the conventional operating room, with intraoperative MRI for resection control. For 5 of these 31 patients, intraoperative resection control revealed significant tumor remnants, which led to further tumor resection guided by the information provided by intraoperative MRI. Intraoperative MRI resection control was performed in 18 transsphenoidal operations. In cases with suspected tumor remnants, the surgeon reexplored the sellar region; additional tumor tissue was removed in three of five cases. Follow-up scans were obtained for all patients 1 week and 2 to 3 months after surgery. For 14 of the 18 patients, the images obtained intraoperatively were comparable to those obtained after 2 to 3 months. Intraoperative MRI was also used for six patients undergoing temporal lobe resections for treatment of pharmacoresistant seizures. For these patients, the extent of neocortical and mesial resection was tailored to fit the preoperative findings of morphological and electrophysiological alterations, as well as intraoperative electrocorticographic findings. CONCLUSION: Intraoperative MRI with the Magnetom Open provides considerable additional information to optimize resection during surgical treatment of supratentorial tumors, pituitary adenomas, and epilepsy. The twin operating theater is a true alternative to a dedicated MRI system. Additional efforts are necessary to improve patient transportation time and instrument guidance within the scanner.

Adolescent↗

PubMed1999

Frameless stereotaxy for transsphenoidal surgery.

OBJECTIVE: To evaluate the utility of performing transsphenoidal surgery with computer-assisted image guidance. METHODS: Thirty-seven patients underwent transsphenoidal surgery in which a frameless stereotactic system was used to confirm the trajectory to the sella and to locate the anatomic midline. This technique was compared with our standard method of using an image intensifier to confirm the approach (n = 43). The numbers of complications associated with the approach, the times required to set up and perform each operation, and the average costs for each group were compared. RESULTS: There were no complications attributable to inaccurate localization from the neuronavigational system. Additional setup time was necessary to calibrate and register the system; this represented a mean of 17 minutes in transsphenoidal procedures performed for the first time (n = 30), whereas reoperations required an average of 22 minutes (n = 7) (P < 0.05). The operative times, defined as time from incision to closure, were not statistically different (P = 0.38). To reduce assistant variation, a subset of this group in which the same assistant was used (n = 18) was analyzed. The additional setup time was reduced to a mean of 12 minutes (P < 0.05). The total case times were actually reduced in this group (127 versus 133 min), but this was not statistically significant (P = 0.75). Fluoroscopy was not required when frameless stereotaxy was used. The cost savings were partially offset by the cost of the preoperative computed tomographic study necessary for fiducial registration and the additional cost of setup time in the operating room. When all factors were analyzed, an additional cost to the patient of $318.00 was noted. The image guidance in axial, coronal, and sagittal planes provided by frameless stereotaxy was subjectively beneficial; it increased our confidence with the approach to the sella and intraoperative localization and was particularly helpful in reoperations where standard anatomic landmarks were distorted. CONCLUSION: Frameless stereotaxy is a technology that provides continuous, three-dimensional information for localization and surgical trajectory to the surgeon and can be applied to transsphenoidal surgery with minimal additional cost and time requirements.

Adult↗

PubMed1999

Endoscopic aqueductoplasty: technique and results.

OBJECTIVE: The purpose of this study was to determine the safety and efficacy of endoscopic aqueductoplasty in patients with hydrocephalus caused by aqueductal stenosis. The controversy of third ventriculostomy and aqueductoplasty is discussed. METHODS: A series of 17 patients who underwent endoscopic aqueductoplasty is reported. Rigid rod-lens scopes were used for inspecting the aqueductal entry and performing balloon aqueductoplasty. With the aid of a 2.5-mm flexible endoscope, the aqueduct and fourth ventricle were explored and aqueductal membranous obstructions were perforated. Third ventriculostomies were performed simultaneously in nine patients. One aqueductal stent was inserted. In six patients, frameless computerized neuronavigation was used for an accurate approach to the aqueduct. The average duration of the endoscopic procedures was 59 minutes (range, 25-100 min). RESULTS: There was no endoscopy-related mortality. Surgical complications included an asymptomatic fornix contusion and two injuries to the aqueductal roof, which resulted in permanent diplopia due to dysconjugate eye movement (one patient) and transient trochlear palsy (one patient). In addition, two patients developed transient dysconjugate eye movements, and one patient had an asymptomatic epidural hematoma. Eleven patients showed improvement in their symptoms. The conditions of five patients were unchanged. One patient died of stroke 1 month after the operation. No patient required shunting. The ventricles decreased in size in nine patients and were unchanged in the remaining eight patients. CONCLUSION: Endoscopic aqueductoplasty is an effective alternative to third ventriculostomy for the treatment of hydrocephalus caused by short aqueductal stenosis. However, longer follow-up periods are necessary to evaluate long-term aqueductal patency after aqueductoplasty.

Adolescent↗

PubMed2000

Clinical evaluation and follow-up results for intraoperative magnetic resonance imaging in neurosurgery.

OBJECTIVE: The use of intraoperative magnetic resonance imaging (MRI) in neurosurgery has increased rapidly, and a variety of concepts have recently been presented. Although the feasibility of the procedure has been demonstrated repeatedly, no conclusive analysis of its effects on the surgical procedures, the extent of tumor removal, and outcomes, or its possible problems, has been performed. METHODS: Of 242 operations performed with intraoperative MRI, 97 procedures for supratentorial glioma treatment were analyzed with respect to intraoperative imaging results and postoperative outcomes. Analysis of the images included assessment of imaging artifacts, image quality, and extent of tumor removal. Patients were monitored to determine radiological progression, survival times, postoperative complications, and morbidity rates. RESULTS: No intraoperative complications related to the imaging procedure were observed. Image quality was good or fair in 85.5% of the cases. Different types of surgically induced imaging changes could be identified. In 56 cases, resection was continued using navigation with intraoperative MRI data sets (rereferencing accuracy, 0.9 mm). For high-grade gliomas, the percentage of cases in which residual tumor was identified by MRI could be significantly reduced from 62% intraoperatively to 33% postoperatively, which was paralleled by a significant increase in survival times for patients without residual tumor. Complication and morbidity rates were within the ranges reported for other studies. CONCLUSION: Intraoperative MRI is safe and allows reliable updating of neuronavigational data, with compensation for brain shifting. Surgically induced imaging changes, which have been identified as a possible problem with intraoperative MRI in general, necessitated comparisons with preoperative scans and require future attention. The extent of tumor removal and survival times were increased significantly. Overall, patients seemed to benefit from the method.

Adolescent↗

PubMed2001

Novel magnetic technology for intraoperative intracranial frameless navigation: in vivo and in vitro results.

OBJECTIVE: To characterize the accuracy of the Magellan electromagnetic navigation system (Biosense Webster, Tirat HaCarmel, Israel) and to demonstrate the feasibility of its use in image-guided neurosurgical applications. DESCRIPTION OF INSTRUMENTATION: The Magellan system was developed to provide real-time tracking of the distal tips of flexible catheters, steerable endoscopes, and other surgical instruments, using ultra-low electromagnetic fields and a novel miniature position sensor for image-correlated intraoperative navigation and mapping applications. METHODS: An image registration procedure was performed, and static and qualitative accuracies were assessed in a series of phantom, animal, and human neurosurgical studies. EXPERIENCE AND RESULTS: During the human study phase, an accuracy error of up to 5 mm was deemed acceptable. Results demonstrated that this degree of accuracy was maintained throughout all procedures. All anatomic landmarks were reached with precision and were accurately viewed on the display screen. Navigation that relied on the system was also successful. No interference with operating room equipment was noted. The accuracy of the system was maintained during regular surgical procedures, using standard surgical tools. CONCLUSION: The system provides precise lesion localization without limiting the line of vision, the mobility of the surgeon, or the flexibility of instruments. Electromagnetic navigation promises new advances in neuronavigation and frameless stereotactic surgery.

Animals↗

PubMed2001

Image-guided placement of eye muscle electrodes for intraoperative cranial nerve monitoring.

OBJECTIVE: Monitoring of the oculomotor system during cranial base or brainstem surgery requires extraocular intraorbital insertion of electromyography electrodes. We investigated the use of image-guidance technology for anatomically correct intraorbital electrode placement. METHODS: For neuronavigation, an optical tracking system was used in a standard fashion. Needle electrodes were inserted percutaneously into the lateral rectus, inferior rectus, and superior oblique muscle along the axis of a hand-held pointer or by means of an electrode applicator to allow direct tracking with the navigation system. Electromyographic monitoring was performed by multichannel recordings of free running or evoked activity from the selected muscles. RESULTS: We have used this method in 10 patients; 5 had cranial base tumors and 5 underwent operations for brainstem lesions. No additional instruments or resources were required compared with the routine setup, and no intraorbital structures were injured. Successful monitoring of oculomotor, trochlear, or abducent nerve function was possible in each case. CONCLUSION: This method may have the potential to increase the safety and success rate of intraoperative electro-ophthalmography during microsurgery focused on preservation of neurological function.

Abducens Nerve↗

PubMed2002

NeuRobot: telecontrolled micromanipulator system for minimally invasive microneurosurgery-preliminary results.

OBJECTIVE: Microneurosurgery can be performed less invasively with the recent advances in neuronavigation and neuroendoscopy. For even less invasive microneurosurgery, we have developed a telecontrolled micromanipulator system. METHODS: The NeuRobot telecontrolled micromanipulator system was developed. With the use of this system, surgical simulations were performed with a human cadaveric head. RESULTS: The system consists of four main parts, i.e., a micromanipulator (slave manipulator), a manipulator-supporting device, an operation-input device (master manipulator), and a three-dimensional display monitor. Three 1-mm forceps and a three-dimensional endoscope, which could be remotely controlled with three degrees of freedom (rotation, neck swinging, and forward/backward motion), were installed in the slave manipulator. All surgical procedures were accurately performed with this system. CONCLUSION: The use of telecontrolled manipulator systems in neurosurgery is very promising, and we are convinced that this system will facilitate more accurate, less invasive microneurosurgery. The details of the NeuRobot system and preliminary results are presented.

Cadaver↗

PubMed2004

ECG artifacts during intraoperative high-field MRI scanning.

High-field magnetic resonance imaging (MRI) (1.5 T) has recently been introduced into the neurosurgical operating room for intraoperative resection control and functional neuronavigational guidance. However, long-lasting neurosurgical procedures in an operating room equipped with a high-field MRI scanner raise new challenges to the anesthesiologist. In particular, monitoring of vital signs during anesthesia requires equipment compatible with working in close vicinity to the strong magnetic field. However, even MRI-compatible electrocardiographic (ECG) monitoring interferes with electromagnetic fields, so several ECG artifacts can be observed in static and pulsed magnetic fields. As shown in this study, pulsed high-frequency fields induce characteristic field frequency-based artifacts in the ECG that can imitate malignant arrhythmia or provoke ST-segment abnormalities. The knowledge of possible and characteristic ECG artifacts during high-field MRI is therefore essential to prevent misinterpretation. Moreover, interference-free parameters such as pulse oximetry or invasive blood pressure curves are highly relevant during intraoperative MRI scans.

Adult↗

PubMed2004

Clinical outcome of epilepsy surgery.

PURPOSE OF REVIEW: The outcome from current surgical methods of treating drug-resistant epilepsy will be considered, looking at changes in classical resective surgery and new methodology being introduced in the functional treatment of these patients. RECENT FINDINGS: There is now class I evidence that temporal lobe surgery is effective. Sophisticated and appropriate magnetic resonance imaging sequences, together with an assessment of the electroclinical syndrome, allow patients to be assessed for resective surgery. The concept of 'surgically remediable syndromes' determines the type of procedure that is effective for particular patients. Technical advances such as neuronavigation techniques and intra-operative magnetic resonance imaging have improved the effectiveness of these procedures. Other techniques of disconnection, such as multiple subpial transection, and stimulation both indirectly using the vagus nerve and directly using various intracranial targets, are currently effective and have potential for future development. SUMMARY: This review will demonstrate that current surgical techniques are safe and effective in relieving drug-resistant epilepsy.

Anterior Temporal Lobectomy↗

PubMed2004

Diagnosis and treatment of pituitary tumors.

PURPOSE OF REVIEW: Treatment of pituitary adenomas remains an interdisciplinary challenge involving neurosurgeons, endocrinologists and radiation oncologists. The different disciplines inaugurated advanced techniques to improve the already relatively high standard of outcome for the benefit of patients, covering molecular pathogenesis, novel therapeutic strategies for the different adenoma subtypes, developments in perioperative magnetic resonance imaging and radiosurgical management of pituitary adenomas. RECENT FINDINGS: Despite the progress achieved in medical treatment of hormone-secreting pituitary adenomas throughout recent years, surgery remains the primary therapy of choice except for prolactinomas. Recent studies in molecular pathogenesis aiming to find novel therapy targets and reports on new pharmacological drugs effecting GH-secreting pituitary adenomas are reviewed (for example, lanreotide 60, SOM320 and pegvisomant). Advances in surgical treatment of pituitary macroadenomas are obtained by pre- and especially by intraoperative (high-field) MRI offering a higher rate of safe and complete tumor removal. Therapy pitfalls mentioned in the literature throughout the last year as well as key points in the management of pituitary adenomas with focus on acromegaly and Cushing's disease are reported. Adjuvant irradiation for recurrent or residual adenomas is often a necessity. In comparison to standard conventional radiation strategies an increasing number of radiation oncologists and neurosurgeons report their experience with radiosurgery especially for smaller tumor remnants in pituitary adenomas. SUMMARY: Recent molecular studies suggest a new level of complexity in the tumorigenisis of pituitary adenomas in terms of possible cell-type-specific molecular changes. Except for prolactinomas surgery remains the primary treatment for pituitary adenomas. New pharmacological drugs achieve very encouraging endocrine results although no long-term follow-up is available so far. The results of trans-sphenoidal surgery will further improve by modern imaging techniques, especially by applying intraoperative high-field magnetic resonance imaging and neuronavigation. The results of radiosurgical techniques with regard to tumor control are mostly convincing, but definitive conclusions on long-term recurrence and/or late complications are not reliable so far.

Adenoma↗