Anatomical Orientation Using Neuronavigation

Chapter 7 - Surgery, Indications and Limitations

Very few randomised, controlled trials have studied the use of standard MRI-based neuronavigation. 

Information about biological tumour extent is very important during the neurosurgical approach to the tumour, and metabolic imaging should be added to basic MRI at preoperative evaluation.

Dural opening and loss of cerebrospinal fluid leads to loss of accuracy, due to brain shift, and removal of tumour mass with the ongoing resection.

Preoperative imaging methods are indirect diagnostic methods only and not suitable for intraoperative real-time analysis.

Significant improvement in the extent of resection could be achieved by using intraoperative MRI (iMRI) in up to 96% of patients, compared with 68% in patients in the control arm (NCT01394692).

However, this significant difference did not persist after stratification for complete resection. Therefore, extent of resection rather than use of iMRI was prognostic.

Intraoperative ultrasound (iUS) can be used repeatedly without significantly disturbing or interrupting the surgical workflow.

iUS is the only tool for real-time acquisition of the intraoperative resection status. It can be easily integrated into standard neuronavigation systems.

Moreover, it allows freehand acquisition of a 3D-reconstruction during surgery without substantial time consumption.

Revision Questions

  1. What are the indications and limitations in the use of neuronavigation in glioma surgery?
  2. Which intraoperative imaging methods can be used and what are their benefits?
  3. Why is intraoperative imaging update so important in glioma surgery?

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Last update: 18 September 2017