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

Yıl 2024, Cilt: 50 Sayı: 2, 289 - 297, 08.10.2024
https://doi.org/10.32708/uutfd.1519795

Öz

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.

Kaynakça

  • 1. Risholm P, Golby AJ, Wells W. Multimodal image registration for preoperative planning and image-guided neurosurgical procedures. Neurosurg Clin N Am. 2011; 22: 197-206. doi:10.1016/J.NEC.2010.12.001
  • 2. Orringer DA, Golby A, Jolesz F. Neuronavigation in the surgical management of brain tumors: current and future trends. Expert Rev Med Devices. 2012; 9: 491-500. doi:10.1586/ERD.12.42
  • 3. Omura N, Kawabata S, Yoshimura K, Yagi R, Furuse M, Wanibuchi M. Using virtual lines of navigation for a successful transcortical approach. Surg Neurol Int. 2023; 14: 1-6. doi:10.25259/SNI_161_2023
  • 4. Barone DG, Lawrie TA, Hart MG. Image guided surgery for the resection of brain tumours. Cochrane Database of Systematic Reviews. 2014; 1: CD009685 doi:10.1002/14651858.CD009685.pub2
  • 5. Willems PWA, Taphoorn MJB, Burger H, Van Der Sprenkel JWB, Tulleken CAF. Effectiveness of neuronavigation in resecting solitary intracerebral contrast-enhancing tumors: a randomized controlled trial. J Neurosurg. 2006; 104: 360-8. doi:10.3171/JNS.2006.104.3.360
  • 6. Spiegel EA, Wycis HT, Marks M, Lee AJ. Stereotaxic apparatus for operations on the human brain. Science. 1947; 106: 349-50. doi:10.1126/SCIENCE.106.2754.349
  • 7. Clarke RH, Horsley SV. The classıc: On a method of investigating the deep ganglia and tracts of the central nervous system (cerebellum). Br Med J 1906:1799-1800. Clin Orthop Relat Res. 2007; 463: 3-6. doi:10.1097/BLO.0B013E31814D4D99
  • 8. Spetzger U, Laborde G, Gilsbach JM. Frameless neuronavigation in modern neurosurgery. Minim Invasive Neurosurg. 1995; 38: 163-6. doi:10.1055/S-2008-1053478
  • 9. Wu JS, Zhou LF, Tang WJ et al. Clinical evaluation and follow-up outcome of diffusion tensor imaging-based functional neuronavigation: A prospective, controlled study in patients with gliomas involving pyramidal tracts. Neurosurgery. 2007; 61: 935-48. doi:10.1227/01.NEU.0000303189.80049.AB
  • 10. Reinges MHT, Nguyen HH, Krings T et al. Course of brain shift during microsurgical resection of supratentorial cerebral lesions: limits of conventional neuronavigation. Acta Neurochir (Wien). 2004; 146: 369-77. doi:10.1007/S00701-003-0204-1
  • 11. Gerard IJ, Kersten-Oertel M, Petrecca K et al. Brain shift in neuronavigation of brain tumors: A review. Med Image Anal. 2017; 35: 403-20. doi:10.1016/J.MEDIA.2016.08.007
  • 12. Gerard IJ, Kersten-Oertel M, Hall JA, Sirhan D, Collins DL. Brain shift in neuronavigation of brain tumors: an updated review of intra-operative ultrasound applications. Front Oncol. 2021; 10: 618837. doi:10.3389/fonc.2020.618837
  • 13. Dorward NL, Alberti O, Velani B et al. Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation. J Neurosurg. 1998;88:656-62. doi:10.3171/JNS.1998.88.4.0656
  • 14. Enchev Y. Neuronavigation: geneology, reality, and prospects. Neurosurg Focus. 2009; 27: e11. doi:10.3171/2009.6.FOCUS09109
  • 15. Willems PWA, Van Der Sprenkel JWB, Tulleken CAF, Viergever MA, Taphoorn MJB. Neuronavigation and surgery of intracerebral tumours. J Neurol. 2006; 253: 1123-36. doi:10.1007/s00415-006-0158-3
  • 16. Akyuz ME, Kadioglu HH. Application of neuronavigation system in intracranial meningioma surgery: a retrospective analysis of 75 cases. Cir Cir. 2022; 90: 92-7. doi:10.24875/CIRU.22000201
  • 17. Dwarakanath S, Suri A, Sharma B, Mahapatra A. Neuronavigation in a developing country: a pilot study of efficacy and limitations in intracranial surgery. Neurol India. 2007; 55: 111-6. doi:10.4103/0028-3886.32780
  • 18. Bonosi L, Marrone S, Benigno UE et al. Maximal safe resection in glioblastoma surgery: A systematic review of advanced ıntraoperative ımage-guided techniques. Brain Sci. 2023; 13: 1-20. doi:10.3390/brainsci13020216
  • 19. Zhang M, Xiao X, Gu G et al. Role of neuronavigation in the surgical management of brainstem gliomas. Front Oncol. 2023; 13: 1159230. doi:10.3389/FONC.2023.1159230
  • 20. Wagner W, Gaab MR, Schroeder HWS, Tschiltschke W. Cranial neuronavigation in neurosurgery: assessment of usefulness in relation to type and site of pathology in 284 patients. Minim Invasive Neurosurg. 2000; 43: 124-31. doi:10.1055/S-2000-8332
  • 21. Pinsker MO, Nabavi A, Mehdorn HM. Neuronavigation and resection of lesions located in eloquent brain areas under local anesthesia and neuropsychological-neurophysiological monitoring. Minim Invasive Neurosurg. 2007; 50: 281-4. doi:10.1055/S-2007-985825
  • 22. Kurtsoy A, Menku A, Tucer B, Oktem IS, Akdemir H. Neuronavigation in skull base tumors. Minimally Invasive Neurosurgery. 2005; 48: 7-12. doi:10.1055/s-2004-830151
  • 23. Dolati P, Gokoglu A, Eichberg D et al. Multimodal navigated skull base tumor resection using image-based vascular and cranial nerve segmentation: A prospective pilot study. Surg Neurol Int. 2015; 6: 172. doi:10.4103/2152-7806.170023
  • 24.Carvi Y, Nievas MN, Höllerhage HG. Reliability ofneuronavigation-assisted trans-sphenoidal tumor resections.Neurol Res. 2007; 29: 557-62. doi: 10.1179/016164107X164184
  • 25.Wei B, Sun G, Hu Q, Tang E. The safety and accuracy ofsurgical navigation technology in the treatment of lesionsınvolving the skull base. J Craniofac Surg. 2017; 28: 1431-4. doi:10.1097/SCS.0000000000003624
  • 26.Sure U, Alberti O, Petermeyer M, Becker R, Bertalanffy H.Advanced image-guided skull base surgery. Surg Neurol. 2000;53: 563-72. doi:10.1016/S0090-3019(00)00243-3
  • 27.Spetzger U, Hubbe U, Struffert T et al. Error analysis in cranialneuronavigation. Minimally Invasive Neurosurgery. 2002; 45:6-10. doi:10.1055/s-2002-23583
  • 28.Wang MN, Song ZJ. Classification and analysis of the errors inneuronavigation. Neurosurgery. 2011; 68: 1131-43. doi:10.1227/NEU.0B013E318209CC45
  • 29.Xue Z, Kong L, Hao S et al. Combined application of sodiumfluorescein and neuronavigation techniques in the resection ofbrain gliomas. Front Neurol. 2021; 12: 747072.doi:10.3389/FNEUR.2021.747072
  • 30.Jung TY, Jung S, Kim IY et al. Application of neuronavigationsystem to brain tumor surgery with clinical experience of 420cases. Minim Invasive Neurosurg. 2006; 49: 210-15. doi:10.1055/S-2006-948305

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

Yıl 2024, Cilt: 50 Sayı: 2, 289 - 297, 08.10.2024
https://doi.org/10.32708/uutfd.1519795

Öz

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.

Kaynakça

  • 1. Risholm P, Golby AJ, Wells W. Multimodal image registration for preoperative planning and image-guided neurosurgical procedures. Neurosurg Clin N Am. 2011; 22: 197-206. doi:10.1016/J.NEC.2010.12.001
  • 2. Orringer DA, Golby A, Jolesz F. Neuronavigation in the surgical management of brain tumors: current and future trends. Expert Rev Med Devices. 2012; 9: 491-500. doi:10.1586/ERD.12.42
  • 3. Omura N, Kawabata S, Yoshimura K, Yagi R, Furuse M, Wanibuchi M. Using virtual lines of navigation for a successful transcortical approach. Surg Neurol Int. 2023; 14: 1-6. doi:10.25259/SNI_161_2023
  • 4. Barone DG, Lawrie TA, Hart MG. Image guided surgery for the resection of brain tumours. Cochrane Database of Systematic Reviews. 2014; 1: CD009685 doi:10.1002/14651858.CD009685.pub2
  • 5. Willems PWA, Taphoorn MJB, Burger H, Van Der Sprenkel JWB, Tulleken CAF. Effectiveness of neuronavigation in resecting solitary intracerebral contrast-enhancing tumors: a randomized controlled trial. J Neurosurg. 2006; 104: 360-8. doi:10.3171/JNS.2006.104.3.360
  • 6. Spiegel EA, Wycis HT, Marks M, Lee AJ. Stereotaxic apparatus for operations on the human brain. Science. 1947; 106: 349-50. doi:10.1126/SCIENCE.106.2754.349
  • 7. Clarke RH, Horsley SV. The classıc: On a method of investigating the deep ganglia and tracts of the central nervous system (cerebellum). Br Med J 1906:1799-1800. Clin Orthop Relat Res. 2007; 463: 3-6. doi:10.1097/BLO.0B013E31814D4D99
  • 8. Spetzger U, Laborde G, Gilsbach JM. Frameless neuronavigation in modern neurosurgery. Minim Invasive Neurosurg. 1995; 38: 163-6. doi:10.1055/S-2008-1053478
  • 9. Wu JS, Zhou LF, Tang WJ et al. Clinical evaluation and follow-up outcome of diffusion tensor imaging-based functional neuronavigation: A prospective, controlled study in patients with gliomas involving pyramidal tracts. Neurosurgery. 2007; 61: 935-48. doi:10.1227/01.NEU.0000303189.80049.AB
  • 10. Reinges MHT, Nguyen HH, Krings T et al. Course of brain shift during microsurgical resection of supratentorial cerebral lesions: limits of conventional neuronavigation. Acta Neurochir (Wien). 2004; 146: 369-77. doi:10.1007/S00701-003-0204-1
  • 11. Gerard IJ, Kersten-Oertel M, Petrecca K et al. Brain shift in neuronavigation of brain tumors: A review. Med Image Anal. 2017; 35: 403-20. doi:10.1016/J.MEDIA.2016.08.007
  • 12. Gerard IJ, Kersten-Oertel M, Hall JA, Sirhan D, Collins DL. Brain shift in neuronavigation of brain tumors: an updated review of intra-operative ultrasound applications. Front Oncol. 2021; 10: 618837. doi:10.3389/fonc.2020.618837
  • 13. Dorward NL, Alberti O, Velani B et al. Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation. J Neurosurg. 1998;88:656-62. doi:10.3171/JNS.1998.88.4.0656
  • 14. Enchev Y. Neuronavigation: geneology, reality, and prospects. Neurosurg Focus. 2009; 27: e11. doi:10.3171/2009.6.FOCUS09109
  • 15. Willems PWA, Van Der Sprenkel JWB, Tulleken CAF, Viergever MA, Taphoorn MJB. Neuronavigation and surgery of intracerebral tumours. J Neurol. 2006; 253: 1123-36. doi:10.1007/s00415-006-0158-3
  • 16. Akyuz ME, Kadioglu HH. Application of neuronavigation system in intracranial meningioma surgery: a retrospective analysis of 75 cases. Cir Cir. 2022; 90: 92-7. doi:10.24875/CIRU.22000201
  • 17. Dwarakanath S, Suri A, Sharma B, Mahapatra A. Neuronavigation in a developing country: a pilot study of efficacy and limitations in intracranial surgery. Neurol India. 2007; 55: 111-6. doi:10.4103/0028-3886.32780
  • 18. Bonosi L, Marrone S, Benigno UE et al. Maximal safe resection in glioblastoma surgery: A systematic review of advanced ıntraoperative ımage-guided techniques. Brain Sci. 2023; 13: 1-20. doi:10.3390/brainsci13020216
  • 19. Zhang M, Xiao X, Gu G et al. Role of neuronavigation in the surgical management of brainstem gliomas. Front Oncol. 2023; 13: 1159230. doi:10.3389/FONC.2023.1159230
  • 20. Wagner W, Gaab MR, Schroeder HWS, Tschiltschke W. Cranial neuronavigation in neurosurgery: assessment of usefulness in relation to type and site of pathology in 284 patients. Minim Invasive Neurosurg. 2000; 43: 124-31. doi:10.1055/S-2000-8332
  • 21. Pinsker MO, Nabavi A, Mehdorn HM. Neuronavigation and resection of lesions located in eloquent brain areas under local anesthesia and neuropsychological-neurophysiological monitoring. Minim Invasive Neurosurg. 2007; 50: 281-4. doi:10.1055/S-2007-985825
  • 22. Kurtsoy A, Menku A, Tucer B, Oktem IS, Akdemir H. Neuronavigation in skull base tumors. Minimally Invasive Neurosurgery. 2005; 48: 7-12. doi:10.1055/s-2004-830151
  • 23. Dolati P, Gokoglu A, Eichberg D et al. Multimodal navigated skull base tumor resection using image-based vascular and cranial nerve segmentation: A prospective pilot study. Surg Neurol Int. 2015; 6: 172. doi:10.4103/2152-7806.170023
  • 24.Carvi Y, Nievas MN, Höllerhage HG. Reliability ofneuronavigation-assisted trans-sphenoidal tumor resections.Neurol Res. 2007; 29: 557-62. doi: 10.1179/016164107X164184
  • 25.Wei B, Sun G, Hu Q, Tang E. The safety and accuracy ofsurgical navigation technology in the treatment of lesionsınvolving the skull base. J Craniofac Surg. 2017; 28: 1431-4. doi:10.1097/SCS.0000000000003624
  • 26.Sure U, Alberti O, Petermeyer M, Becker R, Bertalanffy H.Advanced image-guided skull base surgery. Surg Neurol. 2000;53: 563-72. doi:10.1016/S0090-3019(00)00243-3
  • 27.Spetzger U, Hubbe U, Struffert T et al. Error analysis in cranialneuronavigation. Minimally Invasive Neurosurgery. 2002; 45:6-10. doi:10.1055/s-2002-23583
  • 28.Wang MN, Song ZJ. Classification and analysis of the errors inneuronavigation. Neurosurgery. 2011; 68: 1131-43. doi:10.1227/NEU.0B013E318209CC45
  • 29.Xue Z, Kong L, Hao S et al. Combined application of sodiumfluorescein and neuronavigation techniques in the resection ofbrain gliomas. Front Neurol. 2021; 12: 747072.doi:10.3389/FNEUR.2021.747072
  • 30.Jung TY, Jung S, Kim IY et al. Application of neuronavigationsystem to brain tumor surgery with clinical experience of 420cases. Minim Invasive Neurosurg. 2006; 49: 210-15. doi:10.1055/S-2006-948305
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi (Diğer)
Bölüm Özgün Araştırma Makaleleri
Yazarlar

Alper Türkkan 0000-0002-1437-2396

Ahmet Bekar 0000-0002-2716-1985

Yayımlanma Tarihi 8 Ekim 2024
Gönderilme Tarihi 21 Temmuz 2024
Kabul Tarihi 27 Ağustos 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 50 Sayı: 2

Kaynak Göster

APA Türkkan, A., & Bekar, A. (2024). Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases. Uludağ Üniversitesi Tıp Fakültesi Dergisi, 50(2), 289-297. https://doi.org/10.32708/uutfd.1519795
AMA Türkkan A, Bekar A. Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases. Uludağ Tıp Derg. Ekim 2024;50(2):289-297. doi:10.32708/uutfd.1519795
Chicago Türkkan, Alper, ve Ahmet Bekar. “Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 50, sy. 2 (Ekim 2024): 289-97. https://doi.org/10.32708/uutfd.1519795.
EndNote Türkkan A, Bekar A (01 Ekim 2024) Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases. Uludağ Üniversitesi Tıp Fakültesi Dergisi 50 2 289–297.
IEEE A. Türkkan ve A. Bekar, “Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases”, Uludağ Tıp Derg, c. 50, sy. 2, ss. 289–297, 2024, doi: 10.32708/uutfd.1519795.
ISNAD Türkkan, Alper - Bekar, Ahmet. “Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases”. Uludağ Üniversitesi Tıp Fakültesi Dergisi 50/2 (Ekim 2024), 289-297. https://doi.org/10.32708/uutfd.1519795.
JAMA Türkkan A, Bekar A. Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases. Uludağ Tıp Derg. 2024;50:289–297.
MLA Türkkan, Alper ve Ahmet Bekar. “Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases”. Uludağ Üniversitesi Tıp Fakültesi Dergisi, c. 50, sy. 2, 2024, ss. 289-97, doi:10.32708/uutfd.1519795.
Vancouver Türkkan A, Bekar A. Evaluation of the Use of Intraoperative Neuronavigation in the Surgery of Brain Tumors: Single Center Experience and Retrospective Analysis of 172 Cases. Uludağ Tıp Derg. 2024;50(2):289-97.

ISSN: 1300-414X, e-ISSN: 2645-9027

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