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Role of brain shift in the accuracy of neuronavigation systems during brain tumor surgery
EANS Academy. Toccaceli G. Sep 26, 2019; 276049; EP03098
Abstract
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Introduction: The use of intraoperative neuronavigation systems based on preoperative neuroimaging has largely improved the chance to minimize the surgical approach and increase tumor extent of resection, significantly improving patient prognosis. However, several factors can contribute to alter stereotactic landmarks (brain-shift) making neuronavigation inaccurate.
Objective: The aim of this study is to identify specific factors which could help to predict size and trend of brain shift.
Methods: We included 78 patients operated for brain intra-axial tumors between 2015 and 2017. We used preoperative MRI-guided neuronavigation coupled with intraoperative CT in order to achieve maximal resection. We applied multiple regression analysis with independent variables (multivariate analysis) in order to correlate intraoperative brain-shift to the size of craniotomy, tumor volume, number of lobes involved and head positioning.
Results: We didn´t find significant statistical relationships between brain shift and the analysed variables, except for a weak correlation with the size of craniotomy, which, however, had a negligible impact in some cases only.
Conclusion: Intraoperative navigation, as the only guiding tool during surgical procedures, appears to be outdated. Since brain shift can´t be predicted, the use of different intraoperative imaging tools (iCT, iMR and iUS) to correct brain shift should be promoted and encouraged, together with neuromonitoring, in order to provide a safer and more radical tumor resection.
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