Neuronavigation System In Minimally Invasive Neurosurgery

Objective: To assess the value and safety of neuronavigation system on the resection of intracranial lesions.Methods: 56 patients were randomly divided into neuronavigation group and control group, all of them baring lesions that were either deep located, or small-volumed, or with a less distinct margin, or adjacent to important functional zone. The neuronavigation group was operated under the assistance of VectorVision neuronavigation system supplied by Germany BrainLAB company. The patients had accepted continuous and thin slice MRI or CT scans before operation. Then the image data was transferred to the cranial planning station, the lesions and important surrounding structures were marked out and reconstructed in three-dimentions, the best approaches were designed. After the surgical plan was imported into the cranial navigation station, the patients were registered correctly, then the operation began. In operation, the lesions and important surrounding structures were displayed in real-time which was helpful to determine the length ofscalp incision, the size of bone valve, the incision locations of cerebral cortex, the orientation of surgical approach, and to assess the rate of the resection of lesions. The control group was operated in the conventional way. The outcome of operations of the two groups was statistically analyzed.Results: For the navigation group, the registration deviation of the 28 cases ranged from 0.4 to 2.1mm (mean 1.11 + 0.43mm), the length of scalp incision from 6cm to 15cm (mean 9.36 +2.26cm), the size of bone valve from 5cm2 to 20cm2 (mean 13.36+ 4.05cm2), the length of cortical incision from 2.0cm to 4.5cm (mean 3.14 +0.71cm), the operative time from 95mins to 170mins (mean 130.54 + 21.44min). In all the cases, the lesion sites were reached accurately and smoothly under the neuronavigation; The total lesion removal was achieved in 26 patients, subtotal removal in 2 cases. After operation, the symptoms were relieved in 21 cases, 6 patients showed no improvement, transient hemiplegia was found in 1 case, no operative death and additional severe complications occurred.For the control group, the length of scalp incision ranged from 8cm to 21cm (mean 15.96 + 3.21cm); the size of bone valve from 12cm2 to 49cm2 (mean 30.36 + 9.47cm2); the length of cortical incision from 3.0cm to 5.5cm (mean 4.45 + 0.79cm); the operative time from llOmin to 225min (mean 164.46 +32.lOmin). In the 28 cases, total lesion removal was achieved in 23 patients, subtotal removal in 4 cases, partial removal in 1 case. After operation, the symptoms were relieved in 18 cases, 6 patients showed no improvement; hemiparesis was found in 3 cases, motor aphasia in 1 case; no operative death was found. The two groups showed significant difference on the length of scalp incision, the size of bone valve, the length of cortical incision and the operation time (P<0.01).Conclusions The neuronavigation system is very helpful to make a optimal surgical plan,to improve the accuracy of operations ,to shorten the operation time, The total removal of lesions is increased while the surgical injury and complications are much reduced.