Computer-assisted resection of supra-tentorial cavernous malformation.

Introduction: Resection of cerebral tumors or vascular lesions requires a precise localization to minimize the skin, bone and cerebral approach. The image-guided surgery is currently considered to be of undisputed value in microneurosurgical technique.

Methods: Between 1998 and 2000, 13 patients were operated in our service for resection of a cavernous malformation deeply located using the MRI assisted image guidance (Sofamor-Danek Neuronavigation Cranial 3 System).

Results: The computer-calculated registration accuracy ranged between 0.8 and 2.0 mm (median 1.1 mm). The exact location of the cavernous malformation was possible in all the cases. Total resection of the lesion was always achieved. Operative mortality and transient morbidity were 0 % and 16 %, respectively.

Discussion: The image-guided technique offers a better help than the previously used methods (preoperative localization with CT scan or stereotactic implantation of guiding catheters) to resect intracranial lesions, especially if the lesion is deeply situated in the brain or in an eloquent area. Preoperative MRI-based 3D models, performed using special skin markers, and surgical computer-assisted neuronavigation allow us to find and to resect small and deep lesions with minimal mortality and low morbidity rate.