Abstract.
Cavernous angiomas are mostly small intracranial vascular lesions which can be intraoperatively localized by sonography or stereotactic methods. This paper compares the results of cavernous angioma surgery localized by frame-based vs frameless techniques. Thirty-nine patients with cortical or subcortical lobar cavernoma were operated on by a microsurgical trans-sulcal approach. The localization of the lesion was performed in 19 (49%) patients by frame-based technique and in 20 (51%) patients by frameless navigation. In 22 (56%) of the patients, the cavernomas were located in an eloquent cortical area. Ten of 22 of these lesions were localized by frame-based stereotaxy and 12/22 by frameless navigation. The patients demonstrated the following preoperative symptoms: seizures 20 (51%), hemorrhage 18 (46%), focal neurologic deficit 11 (28%), and headache three (7%), and three (7%) were asymptomatic. Thirteen of 19 patients localized with frame-based stereotaxy were postoperatively asymptomatic or their preoperative neurological symptoms improved. Four of 19 had a transitory neurologic deficit and 2/19 a permanent worsening. Seventeen of 20 patients localized by frameless navigation were asymptomatic or neurologically improved. Three out of 20 suffered from a transient neurologic deficit. Regarding the seizures, 14 (70%) patients were postoperatively free of seizures, three (15%) were improved, and three (15%) were unchanged. The frameless navigation was superior regarding the flexibility for approaches along the skull base and midline, and the frame-based method was superior regarding the accuracy for very small lesions (less than 7 mm). In other cases, both methods were equal. Frame-based and frameless stereotactic methods are useful in the localization of small cavernous angiomas. They make it possible to remove cavernous angiomas in eloquent cortical regions with low risk of a permanent neurologic deficit.
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Grunert, .P., Charalampaki, .K., Kassem, .M. et al. Frame-based and frameless stereotaxy in the localization of cavernous angiomas. Neurosurg Rev 26, 53–61 (2003). https://doi.org/10.1007/s10143-002-0223-z
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DOI: https://doi.org/10.1007/s10143-002-0223-z