Beyin Tümörlerinin Cerrahisinde İntraoperatif Nöronavigasyon Kullanımının Değerlendirilmesi: Tek Merkez Deneyimi ve 172 Vakanın Retrospektif Analizi

Year 2024, Volume: 50 Issue: 2, 289 - 297, 08.10.2024

Alper Türkkan , Ahmet Bekar

https://doi.org/10.32708/uutfd.1519795

Abstract

Nöronavigasyon sistemleri, ameliyat sırasında doğru anatomik oryantasyon ve güvenli rezeksiyon sağlamak için ameliyat öncesi görüntüleme verilerini kullanan bilgisayar destekli prosedürlerdir. Nöroşirürjide yaygın olarak kullanılmalarına rağmen, etkinlikleri ve güvenilirliklerine dair kanıtlar sınırlı kalmaktadır. Bu çalışmanın amacı intrakraniyal tümörlü hastalarda nöronavigasyon sistemlerine olan ihtiyacı, tümörün yeri ve boyutuyla ilişkisini ve sınırlamalarını incelemektir. Ocak 2021 ve Ekim 2023 tarihleri arasında kliniğimizde nöronavigasyon sistemleri kullanılarak ameliyat edilen intrakraniyal tümörlü 172 hasta üzerinde retrospektif bir analiz yapıldı. Hastalar tümör boyutuna göre iki gruba ayrıldı: <3 cm tümörü olanlar ve ≥ 3 cm tümörü olanlar. Ayrıca, supratentoryal, infratentoryal ve kafa tabanı gibi tümör lokasyonlarının yanı sıra yüzeysel ve derin yerleşimli tümör lokasyonlarına göre de sınıflandırma yapılmıştır. Nöronavigasyon sistemlerine duyulan ihtiyaç, ameliyat sırasında verilen 0 ila 2 arasında değişen bir skorlama ölçeği kullanılarak değerlendirilmiştir. Hastaların %49,4'ü erkek, %50,6'sı kadındı ve ortalama yaşları 52,9 ± 16,2 yıldı (dağılım 2-80 yıl). Nöronavigasyon sistemi kullanımı için ortalama toplam puan <3 cm tümörü olan hastalarda ve derin yerleşimli tümörü olanlarda anlamlı olarak daha yüksekti (p = 0.003). Nöronavigasyon ihtiyacı infratentoryal tümörlerde daha azdı. Cerrahi sırasında anatomik ve vasküler yapıların belirlenmesi nöronavigasyon kullanımına en fazla ihtiyaç duyulan cerrahi aşamaydı (n=172, %100). Çok değişkenli ikili lojistik regresyon analizi, tümör boyutunun ≥3 cm ve yüzeysel yerleşimin nöronavigasyon sistemlerine olan ihtiyacı belirleyen risk faktörleri olduğunu ortaya koydu. Supratentoryal ve derin yerleşimli tümörlerde anatomik ve vasküler yapıların belirlenmesi ve <3 cm tümörlerde cerrahi rezeksiyonun değerlendirilmesi nöronavigasyon sistemlerinin kullanımının gerekli olduğu alanlardır.

Keywords

Görüntü rehberliğinde cerrahi, nöronavigasyon, beyin tümörü cerrahisi

Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases

Abstract

Neuronavigation systems are computer-assisted procedures that use preoperative imaging data to ensure accurate anatomical orientation and safe resection during surgery. Despite their widespread use in neurosurgery, evidence of their effectiveness and reliability remains limited. This study aimed to examine the need for neuronavigation systems in patients with intracranial tumors, their relationship with tumor location and size, and their limitations. A retrospective analysis was conducted on 172 patients with intracranial tumors who underwent surgery using neuronavigation systems at our clinic between January 2021 and October 2023. Patients were classified based on tumor size into two groups: those with tumors <3 cm and those with tumors ≥ 3 cm. Further classification was done according to tumor locations such as supratentorial, infratentorial, and skull base, as well as based on superficial and deep-seated tumor locations. The need for neuronavigation systems was assessed using a scoring scale ranging from 0 to 2 assigned during surgery. Of the patients, 49.4% were male and 50.6% were female, with a mean age of 52.9 ± 16.2 years (range 2–80 years). The mean total score for neuronavigation system use was significantly higher in patients with tumors <3 cm and those with deep-seated tumors (p = 0.003). The need for neuronavigation was less in infratentorial tumors. Identifying anatomical and vascular structures during surgery was the surgical stage with the greatest need for neuronavigation use (n=172, 100%). Multivariate binary logistic regression analysis revealed that tumor size ≥3 cm and superficial location were risk factors determining the need for neuronavigation systems. İdentifying anatomical and vascular structures in supratentorial and deep-seated tumors, and evaluating surgical resection in tumors <3 cm are the areas where the use of neuronavigation systems is necessary.

Keywords

Image-guided surgery, neuronavigation, brain tumor surgery

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