Brain Tumor Surgery with Neuronavigation

What is NEURONAVIGATION ?

Neuronavigation is the set of computer-assisted technologies used by neurosurgeons to guide or “navigate” within the confines of the bony skull during surgery.

What does it consist of?

It basically consists of a computer which processes the scans (CT/ MRI) done before surgery and reconstructs the scan to give a multiplanar and three dimensional view of the brain along with the tumor, so that the exact location and extent of the tumor can be made with utmost precision.

The other important component is an infra red dual camera system which tracks the surgeon’s instruments during surgery and displays their position in relation to the tumor on a monitor.

This allows the surgeon to excise the tumor completely without injuring any surrounding structure, as most of the times there may not be a clear delineation between the tumor and the surrounding brain when viewing directly during surgery.

How is it useful to the patient ?

The advantages of Neuronavigation are numerous:

  • Even before starting surgery the surgeon can locate the exact location of tumor from outside and can plan the best possible approach to the tumor
  • The surgeon will be using the smallest possible incision to get into the tumor, resulting in lesser pain and faster recovery for the patient
  • The exposure of the normal brain during surgery is reduced, so that less damage to healthy tissues and lesser complications from surgery.
  • The surgeon can estimate the amount of excision of tumor so that maximal safe resection is achieved with minimal complications.

In what type of surgeries can Neuronavigation be used?

Neuronavigation is useful in all brain surgeries including VP shunt insertion, biopsy and excision of a variety of tumors in the brain, excision of AV malformations and evacuation of hematomas, drainage of abscesses, epilepsy surgeries as well as movement disorder surgeries.

Apart from these Neuronavigation is also useful in various spinal surgeries including fixation of spine with screws, rods and plates.

An example…..

A 59 yr old lady was diagnosed and operated for brain tumor (acoustic neuroma) 3yrs back. Her recent symptoms were suggestive of recurrence of tumor and the same was revealed in the MRI scan. She was operated again but as the tumor was very close to brain stem (vital structure maintaining respiration and heart beat) the tumor could not be removed completely. The patient continued to have the symptoms from the tumor Recently the patient was operated by Dr Paresh Doshi at Jaslok Hospital, Mumbai with the guidance of state-of-the-art Medtronic Neuronavigation system. The tumor was completely removed despite its adherence to the brain stem and the patient recovered well without any additional complications. Post operative contrast CT scan revealed complete excision of tumor.

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