INTERACTIVE INTRAOPERATIVE LOCALIZATION DURING THE RESECTION OF INTRAVENTRICULAR LESIONS

Mass lesions located in the ventricular system can be surgically chall enging. These tumors are often slow growing and reach considerable siz e before they are diagnosed. These lesions commonly cause multiple obs tructions to the circulation of cerebrospinal fluid with subsequent hy drocephalus. They are deeply located in the brain, surrounded by vital neurological and vascular structures, and often have irregular config urations. All these characteristics may pose real problems during surg ery in terms of orientation and a optimal resection. For the surgical approach to such intraventricular lesions we are currently using an in frared-based system implemented at Wayne State University that allows intraoperative real-time localization. Three infrared cameras continuo usly track the position of multiple light-emitting diodes in relation to a predetermined ''rigid body''. This system can be used with differ ent surgical instruments, and does not interfere with standard neurosu rgical techniques, We present our preliminary experience in 18 patient s with intraventricular tumors that were operated on between December 1992 and March 1995. Their lesions were located in the lateral ventric les, third ventricle, and pineal region with extension into the poster ior aspect of the third ventricle. The use of the interactive infrared -based localizing unit allowed a total resection in 15 cases and a sub total resection in 3 cases. We report 3 complications, but only one of them was related to the surgical procedure. The postoperative follow- up period ranged from 2 to 24 months. All patients were followed clini cally and with postoperative magnetic resonance imaging scans. This in teractive infrared system has proven to be a very useful tool, flexibl e, safe a nd reliable, increasing surgical efficiency, without a signi ficant increase in the length of resection.