1 / 23

Advanced Intraoperative Imaging for Parasagittal Meningioma Surgery

Advanced Intraoperative Imaging for Parasagittal Meningioma Surgery. Andrew K. Chan, B.S. M.D. Candidate Sub-Intern Neurological Surgery Service Massachusetts General Hospital. Case Presentation. HPI 48 year old woman Intermittent, dull, bilateral frontal h eadache x 5 weeks

vashon
Download Presentation

Advanced Intraoperative Imaging for Parasagittal Meningioma Surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Advanced Intraoperative Imaging for Parasagittal Meningioma Surgery Andrew K. Chan, B.S. M.D. Candidate Sub-Intern Neurological Surgery Service Massachusetts General Hospital

  2. Case Presentation • HPI • 48 year old woman • Intermittent, dull, bilateral frontal headache x 5 weeks • Worsened the past 4 days, now persistent, n/v, difficulty focusing • Exam • Left Pronator Drift, 4+/5 Left Upper Extremity Strength

  3. Right Parietal Craniotomy for Resection • Left-lateral position, with head down 60 degrees • Monitoring / Imaging: • Central Venous Catheter • Pre-Cordial Doppler • Intraoperative CT scan for BrainLab frameless stereotaxy • Microscope • Removed tumor nearsinus, and removed medial portion of tumor above a draining vein, that was preserved • Frozen Pathology: Meningioma w/o atypical features

  4. Convexity Meningiomas • 391 convexity meningiomas • 60.1 years (19 – 92 years) • WHO I, II, III (90.3, 5.6, 4.1%) • Median Follow-up: 7.1 years (0.0 – 20.9 years) • 1-, 5-, 10-year survival 96%, 89%, 78% • Overall survival associated with age, sex, WHO grade, Simpson grade • 1-, 5-, 10-year retreatment-free survival 99%, 94%, 90% • Retreatment-free survival associated with WHO grade, Simpson grade Hasseleild et al. 2012, J Neurosurg

  5. Convexity Meningiomas 4.9x 13.2x Hasseleild et al. 2012, J Neurosurg

  6. Indocyanine Green Videography

  7. Nussbaum et al. 2012, Neurosurgery

  8. Ueba et al. 2013, J Neurosurg

  9. Eclipse Sign Diminishment of Eclipse Sign Ueba et al. 2013, J Neurosurg

  10. Intraoperative Guidance: Extent of Resection Kim et al. 2011,ActaNeurochir

  11. Intraoperative Guidance: Extent of Resection d’Avella et al. 2013,ActaNeurochir

  12. Conclusions • Aids in the real time, in situ visualization of… • Dural venous sinuses • Cortical arteries and veins • Dural attachment • Select surgical scenarios • Close to major vessels • Approaching highly vascularized tumors • Safe, non-invasive, inexpensive • Future, large series to assess clinical impact

  13. Thank You • Attendings • Residents • Staff • Co-Sub Is • Guy M. McKhann II, MD • Sameer A. Sheth, MD, PhD

  14. Cost Comparison: Transsphenoidal Surgery Eboli et al. 2011, J Neurosurg

  15. Brainlab • Cost • $ 225,000 Watkins et al. 2010 Open Orthop J

More Related