Stereotactic-guided microsurgical removal of lesions without cortical appearance planned by three-dimensional CT reconstruction: Limits and advantages of the frame-based technique

Intraoperative positioning still constitutes a basic problem in the microsu rgical removal of intracerebral lesions, either deep-seated or without cort ical appearance. We treated different types of lesions (cavernous angiomas, intraventricular tumors, gliomas, and metastases), by combining stereotact ic targeting with the standard microsurgical technique. The dedicated softw are for the three-dimensional reconstruction of stereotactic CT images allo wed us to determine the least traumatic surgical trajectory and the exact l ocation of the lesion intraoperatively, with minimum manipulation of health y cerebral tissue. We believe that the main indication for this technique i s the removal of small, encapsulated or well-defined lesions without cortic al appearance or in critical areas, while a direct inspection of the area i s still essential in order to evaluate surgical removal in the case of infi ltrating tumors.