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Neuronavigation with the universal probe to access intracranial targets

Waran V, Chandran H, Devaraj P, Ravindran K, Rathinam AK, Balakrishnan YK, et al.

J Neurol Surg A Cent Eur Neurosurg, 2014 Nov;75(6):422-6.
PMID: 23955263 DOI: 10.1055/s-0033-1345091

The universal probe is a tool devised to allow navigation-directed biopsies and drainage procedures to be performed in a simple manner using a single hardware and software.

Matched MeSH terms: Neuronavigation/instrumentation*; Neuronavigation/methods
Three-dimensional anatomical accuracy of cranial models created by rapid prototyping techniques validated using a neuronavigation station

Waran V, Devaraj P, Hari Chandran T, Muthusamy KA, Rathinam AK, Balakrishnan YK, et al.

J Clin Neurosci, 2012 Apr;19(4):574-7.
PMID: 22305869 DOI: 10.1016/j.jocn.2011.07.031

In neurosurgery and ear, nose and throat surgery the application of computerised navigation systems for guiding operations has been expanding rapidly. However, suitable models to train surgeons in using navigation systems are not yet available. We have developed a technique using an industrial, rapid prototyping process from which accurate spatial models of the cranium, its contents and pathology can be reproduced for teaching. We were able to register, validate and navigate using these models with common available navigation systems such as the Medtronic StealthStation S7®.

Matched MeSH terms: Neuronavigation/education*
The utilization of cranial models created using rapid prototyping techniques in the development of models for navigation training

Waran V, Pancharatnam D, Thambinayagam HC, Raman R, Rathinam AK, Balakrishnan YK, et al.

J Neurol Surg A Cent Eur Neurosurg, 2014 Jan;75(1):12-5.
PMID: 23315670 DOI: 10.1055/s-0032-1330960

Navigation in neurosurgery has expanded rapidly; however, suitable models to train end users to use the myriad software and hardware that come with these systems are lacking. Utilizing three-dimensional (3D) industrial rapid prototyping processes, we have been able to create models using actual computed tomography (CT) data from patients with pathology and use these models to simulate a variety of commonly performed neurosurgical procedures with navigation systems.

Matched MeSH terms: Neuronavigation/methods*
Neuronavigation-guided endoscopic management of a pineal region tumour with obscured floor of the third ventricle: case report

Idris Z, Ghani AR, Idris B, Muzaimi M, Awang S, Pal HK, et al.

Minim Invasive Neurosurg, 2011 Jun;54(3):125-7.
PMID: 21863520 DOI: 10.1055/s-0031-1277198

Shunt surgery is frequently chosen to manage periventricular metastasis of pineal region tumours which obscured the floor of the third ventricle. However, this procedure falls short due to distant metastasis. Neuronavigation-guided endoscopic surgery offers a viable alternative.

Matched MeSH terms: Neuronavigation/instrumentation; Neuronavigation/methods*
Fulltext Multicompartmental congenital intracranial immature teratoma

Ganesan, Dharmendra, Sheau, Fung Sia, Narayann, Vairavan, Kumar, Gnana, Lum, Lucy, Chan,Lucy, et al.

Neurology Asia, 2013;18(1):117-121.
MyJurnal

Congenital intracranial tumors are rare and account for 0.5 to 1.5% of all childhood tumours. We report a case of a 3 week old baby presenting with multi compartmental congenital intracranial immature teratoma, first of its kind in the literature. The child had gross total excision in two stages with aid of neuronavigation. The short term outcome was good. The four years of follow-up with serial imaging showed no tumour recurrence with a stable hydrocephalus after shunting. However, there is global developmental delay with full time dependence of care giver.

Matched MeSH terms: Neuronavigation
The use of intraoperative CT navigation for posterior cervical spine foraminotomy

Tan BH, Sockalingam S, Ganesan D

Br J Neurosurg, 2025 Apr;39(2):262-265.
PMID: 37345453 DOI: 10.1080/02688697.2023.2225611

OBJECTIVES: Posterior cervical foraminotomy is a surgical procedure used to treat unilateral cervical radiculopathy. It provides direct decompression of the nerve root without the necessity of fusion while maintaining cervical mobility. With the advancement in image-guidance technology and minimal access techniques, intra-operative CT has provided a safer, more accurate instrumentation placement with less radiation exposure to operative staff and provides better anatomical visualization quality compared to traditional intra-operative imaging techniques. This case series aims to address the applications of advanced image guidance in posterior cervical foraminotomy and describe the nuances.
METHOD: A technical report on a series of seven cases on intraoperative CT navigation for posterior cervical foraminotomy surgery. Posterior cervical foraminotomy was performed in all patients under CT guided navigation system without an image intensifier. In one case after the foraminotomy, the extruded disc was carefully removed by gentle retraction.
RESULT: From 1 January 2020 to 31 December 2021, a total of seven patients with nine cervical foraminotomy procedures were performed using the aid of CT-guided navigation. The series comprised five women and two men whose mean age was 50.6 years. In all cases, the radiculopathy symptoms were diminished significantly. There were no cases of instability on the dynamic cervical radiograph. There were no complications during the surgical procedure.
CONCLUSION: The navigation also allows the surgeon to localise the index level accurately and appraise the adequacy of the intended decompression in three planes of the CT scan image. The ability to perform accurate spine navigation would be the precursor for robotic spinal surgery.

Matched MeSH terms: Neuronavigation/methods
Fulltext Neuronavigation-guided endoscopic and hodotopic approach to an arachnoid cyst

Idris Z, Nandrajog P, Abdullah JM, Ghani RI, Idris B

Surg Neurol Int, 2013;4:120.
PMID: 24083055 DOI: 10.4103/2152-7806.118492

BACKGROUND: Arachnoid cysts are intraarachnoid benign cystic lesions filled with cerebrospinal fluid and should be treated without incurring further morbidity to the patients.
CASE DESCRIPTION: The authors present a case of a 68-year-old elderly female with a large right fronto-parieto-temporal arachnoid cyst who has been suffering from mild left hemiparesis for the past 4 years and presented with sudden onset of seizures. The 3 Tesla MR system with diffusion tensor imaging (DTI) and MR tractography of the brain showed a large right fronto-parieto-temporal cystic lesion measuring 7 × 5 × 5 cm with a midline shift of 1 cm, suggestive of an arachnoid cyst with surrounding ipsilateral white matter projection pathways and inferior occipito-frontal fasciculus or inferior longitudinal white matter tracts. The cyst was successfully treated with neuronavigation-guided endoscopic and hodotopical approach to fenestrate the arachnoid cyst into the sylvian cistern, avoiding inadvertent injury to major white matter tracts portrayed by DTI. Postoperatively, a repeated computed tomography (CT) scan of the brain revealed a smaller arachnoid cyst with correction of the midline shift. The patient was weaned off from the ventilator and her hemiplegia improved gradually.
CONCLUSION: This case report emphasizes the value of neuronavigation-guided endoscopic and hodotopic approach to fenestrate the intra-axial arachnoid cyst.

Matched MeSH terms: Neuronavigation
Bailouts During Neurointervention; Novel Techniques in Tackling Coil Migration and Premature Intravascular Detachment of Microcatheter Tip

Ambrosanio G, Arthimulam G, Leone G, Guarnieri G, Muto M, Muto M

World Neurosurg, 2020 10;142:167-170.
PMID: 32615295 DOI: 10.1016/j.wneu.2020.06.190

BACKGROUND: Intracranial vascular malformations are increasingly being treated via the endovascular route. Though generally safe, a multitude of intraprocedural complications that potentially lead to disastrous clinical outcomes may arise. It is crucial for the operators to be well versed with the various techniques that are available to overcome any procedure-specific complications.
METHODS: We present 2 cases in which we encountered premature intravascular detachment of the microcatheter tip and coil migration while treating a dural arteriovenous fistula and aneurysm, respectively. We used a stentriever to remove the detached microcatheter tip and suction using the reperfusion catheter to remove the migrated coil, both techniques that have not been reported in the literature thus far.
RESULTS: Detached microcatheter tip and migrated coil were successfully retrieved using a stentriever and aspiration catheter.
CONCLUSIONS: These novel techniques could potentially reduce mortality and morbidity associated with neurointervention.

Matched MeSH terms: Neuronavigation/methods*
Endoscopic fenestration at the splenial-habenular junctional area for symptomatic cavum and tumor at the foramen of Monro: case reports and anatomical review

Idris Z, Johnson JR, Abdullah JM

J. Neurosurg., 2015 Mar;122(3):504-10.
PMID: 25343181 DOI: 10.3171/2014.9.JNS132683

The splenial-habenular junctional area is an alternative site for neuroendoscopic fenestration to divert CSF flow into the quadrigeminal cistern in cases in which endoscopic third ventriculostomy is not amenable. In some patients with obstructive hydrocephalus, the splenium of the corpus callosum can be elevated from the habenular complex. This exposes the membranous connection between the splenium and habenula, which can be fenestrated to divert the CSF flow into the quadrigeminal cistern. This technique can be performed in patients in whom the foramen of Monro or the third ventricle is blocked by a lesion. Here, the authors present 3 complex cases that were managed by neuronavigation-guided transventricular transcavum endoscopic fenestration of the splenial-habenular junctional area. These cases may increase the knowledge and understanding of the anatomy of this region.

Matched MeSH terms: Neuronavigation/methods
A minimally invasive endoscopic transnasal approach to the craniovertebral junction in the paediatric population

Tan SH, Ganesan D, Prepageran N, Waran V

Eur Arch Otorhinolaryngol, 2014 Nov;271(11):3101-5.
PMID: 24986428 DOI: 10.1007/s00405-014-3149-5
Matched MeSH terms: Neuronavigation/methods*
Fulltext Timing of Surgery and Surgical Strategies in Symptomatic Brainstem Cavernomas: Review of the Literature

Rajagopal N, Kawase T, Mohammad AA, Seng LB, Yamada Y, Kato Y

Asian J Neurosurg, 2019 4 3;14(1):15-27.
PMID: 30937003 DOI: 10.4103/ajns.AJNS_158_18

Brainstem cavernomas (BSCs) are angiographically occult, benign low flow vascular malformations that pose a significant surgical challenge due to their eloquent location. The present study includes an extensive review of the literature and three illustrative cases of BSC with emphasis on the timing of surgery: surgical approaches, usage of intraoperative monitoring, and complication avoidance. A systematic search was performed using the PubMed database was from January 1, 1999, to June 2018. The relevant articles were reviewed with particular attention to hemorrhage rates, timing of surgery, indications for surgery, surgical approaches, and outcome. Along with this, a retrospective analysis of three cases of symptomatic BSC, who were operated for the same, during the year 2018 in our institute was conducted. All the three patients presented with at least 1 episode of hemorrhage before surgery. Of these, one patient was operated immediately due to altered sensorium whereas the other two were operated after at least 4 weeks of the hemorrhagic episode. The patients who were operated in the subacute phase of bleed were seen to have liquefaction of hematoma, thus providing a good surgical demarcation and thereby reduced surgery-related trauma to the surrounding eloquent structures. Two patients improved neurologically during the immediate postoperative period, whereas one had transient worsening of neurological deficits during the immediate postoperative period in the form of additional cranial nerve palsies which completely improved on follow-up after 2 months. Radical resection is recommended in all patients with symptomatic BSCs. Surgery should be considered after the first or the second episode of hemorrhage as multiple rebleeds can cause exacerbation of deficits and sometimes mortality as well. Considering surgical timing, anywhere between 4 and 6 weeks or the subacute phase of the hemorrhage is considered appropriate. The aims of surgical intervention must be to improve preoperative function, minimize surgical morbidity and to reduce hemorrhagic rates. In spite of the significant surgical morbidity associated with BSCs, appropriate patient selection, meticulous surgical planning with adjuncts such as intraoperative monitoring and neuronavigation will go a long way in avoidance of major postoperative complications.

Matched MeSH terms: Neuronavigation
Fulltext Endoscopic transnasal approach to anterior and middle cranial base lesions

Tan SH, Brand Y, Prepageran N, Waran V

Neurol India, 2015 Sep-Oct;63(5):673-80.
PMID: 26448224 DOI: 10.4103/0028-3886.166539

We present our experience in managing pathologies involving the anterior and middle cranial base using an endoscopic transnasal approach, highlighting the surgical technique, indications, and complications. The different types of endoscopic approaches used include the transtuberculum/transplanum, transcribiform, transsellar, and cavernous sinus approaches. The common indications include repair of cerebrospinal fluid leaks (both spontaneous and post traumatic) and excision of pituitary adenomas, meningiomas, craniopharyngiomas, esthesioneuroblastomas, and other malignancies of the anterior cranial base. Careful reconstruction is performed with the multilayer technique utilizing fat, fascia lata, and fibrin sealant. The endoscopic transnasal approach, coupled with the present-day sophisticated neuronavigation systems, allows access to lesions in the midline extending from the cribriform plate to the craniovertebral junction. However, preoperative planning and careful selection of cases with evaluation of each case on an individual basis with regard to the lateral extension of the lesion are imperative.

Matched MeSH terms: Neuronavigation