Single-Center Experience in Microsurgical Resection of Acoustic Neurinomas and the Benefit of Microscope-Based Augmented Reality
Background and Objectives: Microsurgical resection with intraoperative neuromonitoring is the gold standard for acoustic neurinomas (ANs) which are classified as T3 or T4 tumors according to the Hannover Classification. Microscope-based augmented reality (AR) can be beneficial in cerebellopontine...
Gespeichert in:
| Autoren: | , , , |
|---|---|
| Format: | Artikel |
| Sprache: | Englisch |
| Veröffentlicht: |
Philipps-Universität Marburg
2024
|
| Schlagworte: | |
| Online-Zugang: | PDF-Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| Zusammenfassung: | Background and Objectives: Microsurgical resection with intraoperative neuromonitoring is
the gold standard for acoustic neurinomas (ANs) which are classified as T3 or T4 tumors according
to the Hannover Classification. Microscope-based augmented reality (AR) can be beneficial in cerebellopontine
angle and lateral skull base surgery, since these are small areas packed with anatomical
structures and the use of this technology enables automatic 3D building of a model without the need
for a surgeon to mentally perform this task of transferring 2D images seen on the microscope into
imaginary 3D images, which then reduces the possibility of error and provides better orientation in
the operative field. Materials and Methods: All patients who underwent surgery for resection of ANs in
our department were included in this study. Clinical outcomes in terms of postoperative neurological
deficits and complications were evaluated, as well as neuroradiological outcomes for tumor remnants
and recurrence. Results: A total of 43 consecutive patients (25 female, median age 60.5 ± 16 years)
who underwent resection of ANs via retrosigmoid osteoclastic craniotomy with the use of intraoperative
neuromonitoring (22 right-sided, 14 giant tumors, 10 cystic, 7 with hydrocephalus) by a
single surgeon were included in this study, with a median follow up of 41.2 ± 32.2 months. A total of
18 patients underwent subtotal resection, 1 patient partial resection and 24 patients gross total resection.
A total of 27 patients underwent resection in sitting position and the rest in semi-sitting position.
Out of 37 patients who had no facial nerve deficit prior to surgery, 19 patients were intact following
surgery, 7 patients had House Brackmann (HB) Grade II paresis, 3 patients HB III, 7 patients HB IV
and 1 patient HB V. Wound healing deficit with cerebrospinal fluid (CSF) leak occurred in 8 patients
(18.6%). Operative time was 317.3 ± 99 min. One patient which had recurrence and one further
patient with partial resection underwent radiotherapy following surgery. A total of 16 patients (37.2%)
underwent resection using fiducial-based navigation and microscope-based AR, all in sitting position.
Segmented objects of interest in AR were the sigmoid and transverse sinus, tumor outline, cranial
nerves (CN) VII, VIII and V, petrous vein, cochlea and semicircular canals and brain stem. Operative
time and clinical outcome did not differ between the AR and the non-AR group. However, use of
AR improved orientation in the operative field for craniotomy planning and microsurgical resection
by identification of important neurovascular structures. Conclusions: The single-center experience
of resection of ANs showed a high rate of gross total (GTR) and subtotal resection (STR) with low
recurrence. Use of AR improves intraoperative orientation and facilitates craniotomy planning and
AN resection through early improved identification of important anatomical relations to structures of
the inner auditory canal, venous sinuses, petrous vein, brain stem and the course of cranial nerves. |
|---|---|
| Beschreibung: | Gefördert durch den Open-Access-Publikationsfonds der UB Marburg. |
| DOI: | 10.3390/medicina60060932 |