Neuronavigator-Assisted Microsurgery For Intracranial Aneurysms

ObjectiveTo evaluate the value of application of neuronavigation to microsurgery for the intracranial aneurysms.Methods(1)Between December of 2014 and December of 2017,we used neuronavigation to operate on 7 patients who were diagnosed with intracranial aneurysms,the 4 patients with middle cerebral artery bifurcation aneurysms,three with peripheral intracranial aneurysms.(2)The accuracy of neuronavigation orientation in the operation were measured.(3)CTA scans were taken to evaluate if there any complications such as infarction,hemorrhage,aneurysm residual etc..All patients outcome were evaluated with Glasgow Outcome Scale when discharge.Results(1)The neuronavigation coordinate error was 0.86~3.22 mm(average 1.39mm).During the operation,6 cases could orientate aneurysm correctly(The neuronavigation coordinate error was 0.86~1.42 mm(average 1.08mm)): the navigational location was uniform the actual aneurysm position.Only 1 case with the P4 posterior cerebral artery which needs the help of intraoperative ultrasound localization because of brain-shift obviously(The neuronavigation coordinate error was 3.22 mm).(2)All the aneurysms were clipped successfully.Imaging reexamination(CTA scan or DSA)confirmed that there was no residual,bleeding,etc.postoperatively.There were complications occurred in two patients,one with oculomotor paralysis,and the other one with anomic aphasia.No massive cerebral infarction,heavy disability and death happened.All patients undertook evaluations with Glasgow Outcome Scale(GOS)when discharge: 5 cases were 5 scales,1 was 4 scales,1 was 3 scales.Conclusions(1)The application of neuronavigation in the peripheral aneurysm of intracranial artery has changed the traditional operation approaches,and neuronavigation helps to reach the aneurysm directly and optimize the surgical procedures.(2)With the aid of navigation,we were able to accurately locate the parent artery and aneurysm in MbifA,and reduce the operation for looking and separating aneurysm,and operate the aneurysm directly.It is worthy of popularization and application.