Application of neuronavigation combined with intraoperative related assistive technology in craniotomy

Objective To explore the role of neuronavigation combined with intraoperative ultrasound Doppler and neurophysiological monitoring in intracranial lesion surgery. Methods A total of 34 patients with intracranial lesions who underwent surgical treatment at Neurosurgery Department of the First Affiliated Hospital of Inner Mongolia Medical University from January 2012 to July 2015 were retrospectively reviewed. All operations were guided by neuronavigation combined with intraoperative ultrasonic Doppler localization. Intraoperative resuscitation and intraoperative electrophysiological monitoring were performed in 10 cases with lesions located at functional areas. Results In 34 cases, brain shift occurred in 24 cases after intraoperative navigation and the distance was 4-13 (6.7±2.4) mm. For ultrasonic assisted navigation, the lesion localizing accuracy rate was 100%. Intraoperative ultrasonography showed that total resection was achieved in 27 cases, subtotal resection in 5 and partial resection in 2. There were 2 cases of transient unilateral motion dysfunction, 1 case of transient language disorder, 1 case of intracranial infection, 1 case of epileptic seizure and no deaths. Postoperative images showed that the brain damage was mild, the cortex was intact and the extent of lesion resection was consistent with intraoperative ultrasound demonstration. None of the 10 patients with functional area lesions showed postoperative functional impairment. Conclusion Neuronavigation combined with intraoperative assistive technology could help precisely localize lesions, protect brain cortex, maximize the removal of lesions and reduce the complications related to the operations. Key words: Brain diseases; Neurosurgical procedures; Neuronavigation; Ultrasonography; Nervous system physiological processes; Intraoperative waken-up