Multimodal Neuronavigation in Microsurgery Resection of BrainStem Tumors.

Background: Microsurgery is a common treatment of brainstem tumors. However, misdirection, vascular damage, nerves injuries, paralysis, even death are all well-known complications, and the risk of adverse events is more likely in less experienced operators. This study was aimed to validate the accuracy of multimodal neuronavigation during microsurgery resection of brainstem tumors.

Methods: Ten patients with brainstem tumors underwent preoperative MRI, diffusion tensor imaging, computed tomography, three-dimensional print, and images loaded into the neuronavigation platform were used for its segmentation and preoperative planning. After patients' registration and subsequent surgical exposure, each segmented brain element was validated by manual placement of the navigation probe to the target.

Results: Preoperative images of the brain matched with three-dimensional print and neuronavigation played important role in all patients. Excellent correspondence between image-based segmentation and microscope view was also evident at the surface of tumors and at the tumor-normal gland interfaces.

Conclusion: Multimodal navigation is a safe and effective method in surgery for patients with brain stem tumors. Our preliminary study is conducted to encourage for future more research with larger numbers of patients.