Intraoperative Navigation in Surgery of Cerebral Tumors

R.A. Lapshin, A.V. Savello, V.E. Parfenov, D.V. Svistov

(Faculty of Neurosurgery, Medicomilitary Academy, Saint Petersburg)

Both cerebral neoplasms and neoplastic processes of another localization are a serious and unsolved problem of high social and economic significance. The purpose of this study has been optimization of methods of intraoperative navigation and estimation of its effect on removal efficiency and immediate results of interventions.

There were 224 males and females, treated and operated for cerebral tumors in the Clinic of Neurosurgery of the Medicomilitary Academy in 2002-2005. All the cases were divided into 2 groups. The first group (operated with intraoperative navigation) included 144 cases. The second group (operated without intraoperative navigation) consisted of 100 cases. We used the StealthStationÔ navigation system (Medtronic, USA). Ultrasonic intraoperative navigation with Aloka, SonoSite and Siemens apparatus and probes, having frequency of 4.0-10 MHz, was performed simultaneously.

The analysis of a histological structure of cerebral tumors demonstrated a considerable number of cases with the most malignant neoplasms in the first group. They were glioblastomas (25%, n=36), anaplastic astrocytomas (17.3%, n=25), brain metastases (14%, n=14). The analysis of results of surgical treatment showed, that intraoperative navigation had increased a quota of totally removed tumors and led to considerable difference in some other important indices. It was confirmed by postoperative CT and MRI examinations.

Thus, intraoperative navigation made it possible to reduce severity of surgical brain trauma and intraoperative blood loss, to increase operation efficiency, to minimize a risk of damage of main eloquent areas and vessels. The immediate postoperative period was characterized by a smaller number of complications and more favorable dynamics of neurological manifestations in cases of the first group.