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803 records · Page 45Linked to original sources
PubMed2005

[A case of atypical meningioma with Lhermitte-Duclos disease].

Lhermitte-Duclos disease is known as an uncommon disease that characterized by a slowly progressive tumor of the cerebellar hemisphere. We present a case of atypical meningioma with Lhermitte-Duclos disease. A 57-year-old female was admitted to our hospital after presenting with general convulsion. CT scan on arrival showed a large mass of the left frontal region and slightly high-density linear lesion in the right cerebellar hemisphere. MRI also revealed well-enhanced mass in the left frontal region and parallel linear striation in the right cerebellar hemisphere. But, the patient had neither cerebellar dysfunction nor signs of increased intracranial pressure. The patient had angioma of the left breast and bilateral benign struma, no typical manifestation of Cowden syndrome. Removal of the frontal tumor caused the convulsion was subsequently performed. The pathological examination was atypical meningioma. After the operation, radiation therapy was not done because of the total removal of tumor and intension on patient side. Fortunately, the patient had no further adverse neurological events postoperatively. However, we should continuously take account to not only the recurrence of meningioma but also the enlargement of the cerebellar lesion and the complication of malignant tumors in whole body.

Cerebellar Neoplasms↗
PubMed2006

[Choice of the surgical approach to petroclival tumor].

OBJECTIVE: To discuss the reasonable choice of the surgical approach to petroclvial tumors. METHODS: The clinical data of consecutive 53 patients with the petroclival tumors, treated from June 2002 to June 2004, were reviewed to compare the different surgical approaches to pertroclival region. RESULT: Subtemporal transtentorial approach were used in 11 patients, suboccipital retrosigmoid approach in 12 patients, (transzygomatic or orbitozygomatic) frontotemporal (pterional) approach in 12 patients, presigmoid sinus approach in 2 patients, subtemporal and retrosigmoid sinus combined approach in 7 patients, subtemporal anterior petrosal extradural approach in 7 patients and extended transfrontal base extradural approach in 2 patients. Of all patients in this group, total tumor removal was achieved in 32 patients, subtotal in 9, largely partial in 12. The new cranial nerve deficit took place in 16 patients postoperatively, two patients died from coma and serious pneumonia. CONCLUSIONS: Using perfect microsurgical technique, conventional surgical approaches on petroclival region such as suboccipital retrosigmoid approach, subtemporal transtentorial approach can be suitable for most petroclival tumor with the help of neuro-navigation and neuro-endoscopy. To the epidural tumor on petroclival region, the epidural approach should be used with less invasion to the brain tissue. And to the giant petroclival tumor, the combined-tentorial approach can provide an excellent access and exposure to the tumor.

Adolescent↗
PubMed2006

[Anatomic study on the design of far-lateral transcondylar transtubercular keyhole approach assisted by neuro-navigation].

OBJECTIVE: To design a new far-lateral transcondylar transtubercular keyhole approach assisted by neuro-navigation system according to the keyhole idea, and to explore the possibility of removing the occipital condyle and jugular tubercle precisely. METHODS: Navigation data were established on 8 cadaveric heads fixed by formalin and with their intracranial vessels perfused with colored silicone. Before the operation, circumscriptions of the occipital condyle and jugular tubercle were outlined with different colors in the navigation system in order to aid drilling them in operation. A 7 cm longitudinal "S" shaped skin incision was performed with its superior border 2 cm behind the middle point of mastoid and inferior margin at the level of C(2). After inverting the suboccipital muscles and exposing the far lateral part of the occipital bone, occipital condyle, hemilamina of C(1), vertebral artery and posterolateral portion of foramen magnum, a retro-condylar bone flap 3 cm in diameter was cut. Assisted by neuro-navigation, not only were the maximal angle of visual field measured before and after the 1/3 and 1/2 posteromedial occipital condyle removal respectively, but also the anatomic structures were observed and measured. RESULTS: The incision of the retro-condylar keyhole approach fully met the needs of the far-lateral transcondylar transtubercular keyhole approach; partial occipital condyle and jugular tubercle could be precisely drilled with the aid of neuro-navigation, thus avoiding the bewilder in drilling process; the maximal angles of visual field were 39.2 degrees +/- 3.29 degrees (before condyle drilled), 51.5 degrees +/- 2.45 degrees (1/3 condyle drilled) and 57.5 degrees +/- 2.66 degrees (1/2 condyle drilled) respectively, and there were significant difference among them (P < 0.01). CONCLUSION: It is feasible to perform the far-lateral trascondylar transtubercular keyhole approach; the maximal angle of visual field is obviously increased by drilling partial occipital condyle, and the middle clivus can be increasingly exposed through removal of jugular tubercle.

Adult↗
PubMed2006

[Application of diffusion tensor imaging fractography in minimally invasive surgery of brain tumors].

OBJECTIVE: To investigate the effects and prospect of application of diffusion tensor imaging (DTI) fractography in minimally invasive surgery of brain tumors. METHODS: DTI fractography was performed in 52 patients with malignant brain tumors. Based on the DTI fractography results, 34 of the 52 patients underwent operation under neuro-navigation, and 18 of the 52 patients underwent operation routine minimally invasive craniotomy and tumor resection without neuro-navigation. RESULTS: The rate of total tumor resection was 86.5% (45/52). The mortality was 1.9% (1/52). The disability rate was 11.5% (6/52). No case needed the second operation. CONCLUSION: DTI fractography has raised the minimally invasive neurosurgery to the level of protecting the nuclei and nerve tracts and guiding intra-operative management of infiltration of deep-seated tumors, especially when combined with neuro-navigation and interventional MRI.

Adolescent↗
PubMed2006

Improved delineation of glioma margins and regions of infiltration with the use of diffusion tensor imaging: an image-guided biopsy study.

BACKGROUND AND PURPOSE: The efficacy of radiation therapy, the mainstay of treatment for malignant gliomas, is limited by our inability to accurately determine tumor margins. As a result, despite recent advances, the prognosis remains appalling. Because gliomas preferentially infiltrate along white matter tracks, methods that show white matter disruption should improve this delineation. In this study, results of histologic examination from samples obtained from image-guided brain biopsies were correlated with diffusion tensor images. METHODS: Twenty patients requiring image-guided biopsies for presumed gliomas were imaged preoperatively. Patients underwent image-guided biopsies with multiple biopsies taken along a single track that went into normal-appearing brain. Regions of interest were determined from the sites of the biopsies, and diffusion tensor imaging findings were compared with glioma histology. RESULTS: Using diffusion tissue signatures, it was possible to differentiate gross tumor (reduction of the anisotropic component, q > 12% from contralateral region), from tumor infiltration (increase in the isotropic component, p > 10% from contralateral region). This technique has a sensitivity of 98% and specificity of 81%. T2-weighted abnormalities failed to identify the margin in half of all specimens. CONCLUSION: Diffusion tensor imaging can better delineate the tumor margin in gliomas. Such techniques can improve the delineation of the radiation therapy target volume for gliomas and potentially can direct local therapies for tumor infiltration.

Adolescent↗
PubMed2006

[Visualization and real-time tracking of the instruments in surgical navigation system].

In order to realize the visualization and real-time tracking of the instruments in surgical navigation system, we use the CAD solid model of the instruments directly or by reverse engineering, and transform the solid model to surface model. Then, the instruments, which are fixed with locator, are characterized and tested their precision. After registration between the CT model and the patient site in intra-operation, the system accurately displays the STL model of the instruments according to the tracked site and orientations. The model construction of the instruments is the base of the surgical navigation and is important to improve the security and precision of operation.

Computer Simulation↗
PubMed2006

[Function magnetic resonance imaging and diffusion tensor tractography in patients with brain gliomas involving motor areas: clinical application and outcome].

OBJECTIVE: To explore the role of preoperative blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) and diffusion tensor tractography (DTT) to identify the relationship between motor cortical area, pyramidal tracts with brain gliomas in neurosurgical treatment of intraoperative electrical stimulation for gliomas involving motor areas at 3T. METHODS: Twenty-eight patients with brain gliomas involving motor areas were included. They underwent MRI examination, which included conventional T1WI, T2WI, BOLD-fMRI of bilateral hands movement paradigm and diffusion tensor imaging (DTI). The data of BOLD-fMRI and DTI were transferred to the workstation (Leonardo syngo 2003A, Siemens) and analyzed. Activation mapping of hands movement, fractional Anisotropy (FA) Color and three dimensional pyramidal tracts were produced. The relationship between motor cortical area, pyramidal tracts and brain gliomas was demonstrated, which was used to optimize the pre-surgical planning. With guidance of the result of BOLD-fMRI and DTT, all patients received microsurgery under anaesthesia retaining consciousness using intraoperative motor functional brain mapping with the method of direct electrical stimulations. The brain lesions were removed as far as possible in the case of eloquent areas and sub-cortical important white matters preservation. The preoperative and postoperative KPS of all patients were operated to evaluate the state of patients. RESULTS: BOLD-fMRI, DTI were performed successfully in 28 patients. The relationship between the primary motor cortex, premotor area, supplementary motor area, pyramidal tracts and brain gliomas localized by preoperative fMRI and DTI. Under anaesthesia retaining consciousness, the primary motor area was monitored by the method of direct electrical stimulations with the guidance of preoperative BOLD-fMRI. There was good correlation between preoperative fMRI and intraoperative cortical stimulation. Furthermore, the preoperative mappings and DTT could make up for the un-monitored motor areas and pyramidal tracts during operative cortical stimulation. Comparing the preoperative KPS, the postoperative KPS was advanced. CONCLUSIONS: BOLD-fMRI and DTT could non-invasively localize the relationship between brain motor cortex, pyramidal tracts and brain gliomas in vivo to optimize the surgical planning, guide the microsurgery under anaesthesia retaining consciousness using intraoperative motor functional brain mapping with the method of direct electrical stimulations and remove brain tumors as far as possible in the case of eloquent areas and sub-cortical important white matters preservation.

Adult↗
PubMed2007

[Information guided technology and procedure in neurosurgical field].

Translational Research is the research to apply and mediate a fundamental research result to the clinical field effectively. The integration of the diagnosis and the treatment is an important item in the life science field from the viewpoint of quality of therapy and minimally invasive therapy. The standardization of mechanical interface of the medicine related machine, system and a medical information system are important from the viewpoint such as prevention of medical malpractice. A high function operating robot (manipulator) as an endoscopic robot and image-guided minimally invasive device are important in the point of view of the development of a medical device shown with a medical device industry vision. We describe an outline of our ongoing development of endoscope system, intraoperative MRI (intelligent operating theater) and robot surgery system in neurosurgical field.

Humans↗