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Quantification and comparison of neurosurgical approaches in the preclinical setting: literature review

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Abstract

There is a growing awareness of the need for evidence-based surgery and of the issues that are specific to research in surgery. Well-conducted anatomical studies can represent the first, preclinical step for evidence-based surgical innovation and evaluation. In the last two decades, various reports have quantified and compared neurosurgical approaches in the anatomy laboratory using different methods and technology. The aim of this study was to critically review these papers. A PubMed and Scopus search was performed to select articles that quantified and compared different neurosurgical approaches in the preclinical setting. The basic characteristics that anatomically define a surgical approach were defined. Each study was analyzed for measured features and quantification method and technique. Ninety-nine papers, published from 1990 to 2013, were included in this review. A heterogeneous use of terms to define the features of a surgical approach was evident. Different methods to study these features have been reported; they are generally based on quantification of distances, angles, and areas. Measuring tools have evolved from the simple ruler to frameless stereotactic devices. The reported methods have each specific advantages and limits; a common limitation is the lack of 3D visualization and surgical volume quantification. There is a need for a uniform nomenclature in anatomical studies. Frameless stereotactic devices provide a powerful tool for anatomical studies. Volume quantification and 3D visualization of the surgical approach is not provided with most available methods.

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Acknowledgments

FD was in part sponsored by a grant from the Fondazione “Giuseppe Alazio,” via Torquato Tasso, 22, 90144 Palermo, Italy (www.fondazionealazio.org).

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Authors and Affiliations

  1. Division of Neurosurgery, Toronto Western Hospital, UHN, Toronto, ON, Canada

    F. Doglietto, I. Radovanovic, G. Zadeh & F. Gentili

  2. Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy

    F. Doglietto & E. Fernandez

  3. Division of Neurosurgery, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy

    F. Doglietto & M. M. Fontanella

  4. Division of Anatomy, University of Toronto, Toronto, ON, Canada

    M. Ravichandiran & A. Agur

  5. Division of Radiology, Toronto General Hospital, UHN, Toronto, ON, Canada

    J. Qiu & W. Kucharczyk

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  1. F. Doglietto
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Comments

Pasquale De Bonis, Ferrara, Italy

In this paper, Doglietto et al. documented a wide variability in addressing the anatomical features of neurosurgical approaches. The authors conclude that a uniform nomenclature and avoidance of ambiguous terms will improve future anatomo-surgical studies.

The problem of a rigorous and uniform nomenclature is timely in all aspects of neurosurgery, both for preclinical-anatomical studies and for clinical studies. This should also be applied to spinal surgery, where dozens of terms indicating the same approach (with or without little variants) only determine confusion. A classical example is the “far-lateral approach” for the lumbar spine. This approach has been called intermuscular, muscle-splitting, paravertebral, inter-transverse, extraforaminal, and with some eponyms.

I agree with the authors that a reproducible volume quantification and 3D visualization of the surgical approach both for cranial and for spinal surgery are strongly needed. At present, several frameless stereotactic devices exist and several tools have been created, with the help of biomedical engineers, whose role is more and more important. These tools could be useful both for surgical planning and preclinical anatomical studies. Moreover, these could also be very precious for creating a 3D map of the operating field and of anatomical structures for the surgeons in training.

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Table S1

Review of comparative, quantitative anatomical studies on neurosurgical approaches. (DOCX 158 kb)

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Doglietto, F., Radovanovic, I., Ravichandiran, M. et al. Quantification and comparison of neurosurgical approaches in the preclinical setting: literature review. Neurosurg Rev 39, 357–368 (2016). https://doi.org/10.1007/s10143-015-0694-3

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