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Image-Guided Navigational Microsurgery for Skull Base and Brainstem Diseases

Frameless stereotactic microsurgery with the aid of the Mehrkoordinaten Manipulator (MKM) and the Surgical Microscope Navigator (SMN) systems was used for 66 patients with lesions involving the skull base and brainstem. Our clinical results demonstrated that anatomical relations between the lesion and surrounding structures of the skull base and brainstem remained constant during surgery. In addition, the systems yielded frameless stereotactic access to the small deep-seated lesions, safer skull base drilling, and removal of the skull base and brainstem lesions, all of which contributed to better surgical results than those obtained with classic microsurgical techniques. The accuracy of the navigational systems differed according to registration protocols, surgical procedures, and performance of the systems. The navigational systems required different degrees of precision depending on the surgical procedures and targeted area. In some difficult cases, image-guided microsurgery should be combined with some form of real-time monitoring to allow for intraoperative diagnosis of total resection of the lesions.