| Clinical Experiences of Frameless Navigation System for Brain
Tumor Surgery in Geriatric Patients |
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Kyoung-Han Kim , Jung-Yul Park , Dong Jun Lim, Sang-Dae Kim , Yong-Gu Chung |
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Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea |
| 노인 환자에서 뇌항법 장치를 이용한
뇌종양 수술의 임상 경험 |
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| Abstract |
Objective
Frameless stereotactic systems, or neuronavigation systems can provide a real-time surgical localization
and guidance for complete removal of brain lesion during operation. Their use has become increasingly popular
in routine neurosurgical practice. The goal of this study was to investigate the effectiveness of the neuronavigation
system in its application to the brain tumor surgery in geriatric patients.
Methods
We analyzed 75 patients, age over 65 years with brain tumors undergoing image-guided surgery with
the aid of the Stealth Neuro-station from April 2004 through December 2007. All patients underwent magnetic
resonance (MR) or computed tomography (CT) imaging as well as special neuronavigation imaging acquired using
scalp fiducial markers. Twently-nine patients underwent the burr-hole and biopsy for the mass-like lesions. And,
46 patients underwent the debulking operation of tumors. The extent of tumor removal. brain pathological conditions,
location, morbidity and mortality as well as the incidence of brain tumor in this age group were analyzed.
Results
Thirty-seven male and thirty eight female patients who underwent 75 surgical procedures were included
in this study. The most common one was meningioma (22, 29.3), followed by metastatic tumor (21, 28%), high
grade glioma (17, 22.7%), low grade glioma (7, 9.3%), and pituitary adenoma (6, 8%) in the order of frequency.
Surgical outcome was good with acceptable operative morbidity and mortality rate in 22.7% and 2.6% of patients,
respectively. The most common postoperative surgical complications were tumor bed bleeding and wound infection.
During perioperative course, medical complications such as cardiovascular problem, pneumonia and sepsis were
more common than those in general. Surgical population Gross total removal of the tumor was performed in 32
cases (mean remnant mass 3.2%) out of all 46 tumors. However, subtotal removal of the tumor was done in 14
cases (mean remnant mass 35.2%) with neuronavigation assist.
Conclusion
Incidence of combined medical problems in the geriatric patients was considerably high. The neuronavigation
system has shown to be very effective and accurate application for routine microsurgical interventions.
The application of this technique not only revealed more benefits in operative planning, appreciation of anatomy,
and lesion location, but also safety of surgery in the geriatric patients. |
| Key Words:
NeuronavigationㆍBrain tumorㆍImage guided surgeryㆍGeriatric patients |
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