Article
The role of image guidance for surgery of subinsular cavernoma
Navigationsgesteuerte Resektion insulärer Kavernome
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Published: | May 8, 2006 |
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Objective: Surgical treatment of cavernomas arising below the medial insular cortex is especially challenging due to the proximity to the internal capsule and lenticulostriate arteries. We present our technique of image guidance for the surgery of such subinsular cavernomas and assess its clinical usefulness.
Methods: Between 1997 and 2005 we operated on 12 patients harboring a subinsular cavernoma with the guidance of a frameless stereotactic system (BrainLab AG, Munich, Germany). The neuronavigation was used (1) for accurate planning of the craniotomy, (2) for identification of the distal Sylvian fissure and finally (3) for finding the exact site of insular corticotomy. Image guided ultrasonography was used as an additional intraoperative imaging modality. Postoperative clinical and neuroradiological evaluations were performed in each patient.
Results: The navigation system worked properly in all 12 neurosurgical cases. Exact planning of the approach and determination of the ideal trajectory for cavernoma was possible in every case. All cavernomas were readily identified and completely removed using microsurgical technique. No surgical complication occurred, and the postoperative course was uneventful in all patients.
Conclusions: Image guidance during surgery of subinsular cavernomas provides high accuracy for lesion targeting and permits excellent anatomical orientation. Accordingly, safe exposure can be obtained due to a tailored dissection of the Sylvian fissure and minimal insular corticotomy.