Document Detail

Image-guided craniotomy for frontal sinus preservation during meningioma surgery.
MedLine Citation:
PMID:  18042499     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Preservation of the frontal sinus (FS) during the frontolateral approach to the skull base reduces morbidity, enhances patient comfort, and speeds up the surgical procedure. Due to its irregular outline, mental reconstruction of the borders of FS from two-dimensional images is challenging during surgery. This study was designed to evaluate the impact of neuronavigation on identification and preservation of the FS during frontolateral craniotomies. METHODS: Forty-five patients with pathologies located in the anterior skull base and in the parasellar region were included. A standard computed tomography (CT) sequence was obtained from each patient and uploaded onto an image-guidance system for volumetric rendering of 3D images. The outline of the FS was visualized and the distance between its lateral border and the mid-pupillary line (MPL) was measured. The results were used for navigated craniotomies and compared to the intra-operative findings. RESULTS: The FS was located medial, on and lateral to the MPL in 32, 4 and 9 cases, respectively. The individual outline of the FS could be identified with a mean target registration error of 1.4mm (+/-0.7 mm). The craniotomy could be custom-tailored for each patient according to the individualized landmarks while visualizing the lesion and the surgical landmarks simultaneously. Unintended opening of the frontal sinus or orbit did not occur in any of these cases. CONCLUSION: Image-guided craniotomies based on 3D volumetric image rendering allow for fast and reliable demarcation of complex anatomical structures hidden from direct view in frontolateral approaches. The outline of the frontal sinus and the orbit can be appraised at a glance providing additional safety and precision during craniotomy.
A Gharabaghi; B Krischek; G C Feigl; S K Rosahl; W Lüdemann; M J Mirzayan; A Koerbel; M Samii; M Tatagiba; S Heckl
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Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2007-11-26
Journal Detail:
Title:  European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology     Volume:  34     ISSN:  1532-2157     ISO Abbreviation:  Eur J Surg Oncol     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-07-14     Completed Date:  2008-07-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8504356     Medline TA:  Eur J Surg Oncol     Country:  England    
Other Details:
Languages:  eng     Pagination:  928-31     Citation Subset:  IM    
Eberhard Karls University, Tübingen, Germany; International Neuroscience Institute, Hannover, Germany.
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MeSH Terms
Craniotomy / methods
Frontal Sinus / surgery*
Meningeal Neoplasms / surgery*
Meningioma / surgery*
Neuronavigation / methods
Tomography, X-Ray Computed

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