INTERACTIVE IMAGE-GUIDED SURGERY OF THE PINEAL REGION

A wide variety of lesions occur in the pineal region. Of these, only 2 5% may benefit from surgical resection, being benign or radioresistant in nature. In the remaining 75% (malignant or radiosensitive), a cons ervative approch is preferred. Surgical resection of lesions arising f rom the pineal region has been associated with high morbidity and mort ality, due to the complex microanatomy of this area. Recently computer -assisted surgery has emerged as an ideal method to safely approach ma ny intracranial lesions. In the present study we discuss our experienc e in interactive image-guided surgical management of pineal mass lesio ns, in terms of patient selection, methodology, and surgical morbidity and mortality. From July 1992 to December 1996, 15 patients underwent interactive image guided surgical procedures. There were eight men an d seven women. Age ranged from 5 to 79 years (mean 30). Preoperatively all patients underwent neuroimaging studies that included computed to mography and magnetic resonance imaging under stereotactic conditions. Surgical planning was carried out using the Neurological Surgical Pla nning System software developed at Wayne State University. In patients with a preoperative diagnosis of a malignant or radiosensitive lesion (n=10), an interactive image-guided stereotactic biopsy was considere d, whereas for those with benign or radioresistant lesions (n = 5) sur gical excision using an infrared based system was carried out. Histolo gical diagnosis was obtained in all patients. There was no morbidity a nd mortality associated with computer-assisted procedures for biopsies the diagnostic yield was 100%. For patients that underwent interactiv e image-guided surgery, gross total removal was accomplished in 3 and in 1 patient a subtotal resection greater than 90% was achieved. Inter active image-guided biopsy represents a safe and accurate method in th e diagnosis of malignant and/or radiosensitive pineal lesions. Using t his technique surgeons can simulate preoperatively the surgical trajec tory, thus avoiding damage to critical and vascular structures. For pa tients with ben ig n or radioresistant lesions, computer-assisted surg ical excision is recommended.