The use of modern microneurosurgical methods and state of the art technologies in the treatment of brain tumors and neurovascular diseases

Overview

Brain tumors and neurovascular diseases represent the most frequent and serious areas of intracranial neurosurgery. The recent advances in microneurosurgery aim at the complete treatment of the lesions (i.e. radical removal of the tumor, total occlusion of the vascular malformation) while respecting the minimal invasivity for the patient and avoiding risks and morbidity of the surgical procedure. The main tools used in order to accomplish this end are partly meticulous application of recent microneurosurgical principles that enable to treat complicated and deep lesions with minimal retraction and risk of injury to nerves and vascular structures, partly the use of contemporary technologies. Neuronavigation and functional neuronavigation facilitate exact preoperative planning and intraoperative orientation, methods based on fluorescence help to display intravascular blood flow or residual tumor in the operative field and intraoperative magnetic resonance allows exact morphological imaging of the intracranial structures during surgical procedure and increases accuracy of navigation. Electrophysiological monitoring helps to increase the safety of the procedure by continuous tracking of selected brain and nerve functions. Tailored combination and cooperation of aforementioned methods maximizes effect for the uneventful outcome. We present review paper on application of these methods and our experiences in the neurosurgical department Na Homolce hospital and show illustrative cases.

Key words:
microneurosurgery, brain retraction, neuronavigation, intraoperative magnetic resonance.