Abstract
Purpose
Frameless stereotactic neurosurgery is increasingly being used for the biopsy of intracranial tumors and the resection of deep-seated lesions where reliance on surface anatomic landmarks can be misleading, as well as in movement disorders, psychiatric disorders, seizure disorders, and chronic refractory pain. Nascent biological approaches, including gene therapy and stem-cell and tissue transplants for movement disorders, also utilize neuronavigational techniques. These procedures are complex and involve understanding of the basic principles and factors affecting neuronavigation. The procedure may appear to be simple, but serious complications may occur.
Methods
The purpose of this study was to review the intraoperative and postoperative complications occurring during frameless stereotaxy at our institution from January 2003 to July 2007.
Results
Seventy-eight patients underwent various neurosurgical procedures under general anesthesia. Intraoperative complications seen were intraoperative brain bulge (n = 3), seizures (n = 3), failure to extubate (n = 4), and fresh neurodeficits (n = 6). No hemodynamic disturbances such as hypertension or hypotension or bradycardia or tachycardia requiring active intervention were observed.
Conclusion
Awareness and vigilance can help in the early identification and better management of the above intraoperative complications.
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References
Apuzzo ML, Chandrasoma PT, Cohen D, Zee CS, Zelman V. Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses. Neurosurgery. 1987;20:930–937.
Hall WA. The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer. 1998;82:1749–1755.
Ostertag CB, Mennel HD, Kiessling M. Stereotactic biopsy of brain tumors. Surg Neurol. 1980;14:275–283.
Marshall LF, Jennett B, Langfitt TW. Needle biopsy for the diagnosis of malignant glioma. JAMA. 1974;228:1417–1418.
Wen DY, Hall WA, Miller DA, Seljeskog EL, Maxwell RE. Targeted brain biopsy: a comparison of freehand computed tomography-guided and stereotactic technique. Neurosurgery. 1993;32:407–413.
Nauta HJ. Error assessment during “image guided” and “imaging interactive” stereotactic surgery. Comput Med Imaging Graph. 1994;18:279–287.
Paleologos TS, Dorward NL, Wadley JP, Thomas DG. Clinical validation of true frameless stereotactic biopsy: analysis of the first 125 consecutive cases. Neurosurgery. 2001;49:830–837.
Nimsky C, Ganslandt O, Kober H, Moller M, Ulmer S, Tomandl B, Fahlbusch R. Integration of functional magnetic resonance imaging supported by magnetoencephalography in functional neuronavigation. Neurosurgery. 1999;44:1249–1256.
Nimsky C, Ganslandt O, Cerny S, Hastreiter P, Greiner G, Fahlbusch R. Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging. Neurosurgery. 2000;47:1070–1080.
Nabavi A, Black PM, Gering DL, Westin CF, Mehta V, Pergolizzi RS Jr, Ferrant M, Warfield SK, Hata N, Schwartz RB, Wells WM III, Kikinis R, Jolesz FA. Serial intraoperative magnetic resonance imaging of brain shift. Neurosurgery. 2001;48:787–798.
Venkatraghavan L, Manninen P, Mak P, Lukitto K, Hodaie M, Lozano A. Anesthesia for functional neurosurgery: review of complications. J Neurosurg Anesthesiol. 2006;18:64–67.
Stokes MA, Soriano SG, Tarbell NJ, Loeffler JS, Alexander E 3rd, Black PM, Rockoff MA. Anesthesia for stereotactic radiosurgery in children. J Neurosurg Anesthesiol. 1995;7:100–108.
Roberts DW, Hartov A, Kennedy FE, Miga MI, Paulsen KD. Intraoperative brain shift and deformation: a quantitative analysis of cortical displacement in 28 cases. Neurosurgery. 1998;43:749–760.
Anesthesia for neurosurgery. In: Morgan GE Jr, Mikhail MS, Murray MJ, editors. Clinical anesthesiology. New York: Lange Medical Books/McGraw-Hill Medical Publishing Division; 2002. p. 567–582.
Bernstein M, Parrent AG. Complications of CT guided stetotactic biopsy of intra-axial brain lesions. J Neurosurg. 1994;81:165–168.
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Ali, Z., Prabhakar, H., Bithal, P.K. et al. A review of perioperative complications during frameless stereotactic surgery: our institutional experience. J Anesth 23, 358–362 (2009). https://doi.org/10.1007/s00540-009-0759-y
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DOI: https://doi.org/10.1007/s00540-009-0759-y