advanced neuro endoscopy

Advanced Endoscopic Navigation

M. Triffaux

Stealth Users Meeting 17 March 2006

Neuroendoscopy •  Introduction

Endoscopy

Navigation

Neuroendoscopy •  « Minimally Invasive Surgery »

Ventriculoscopy Pituitary Key hole surgery

Neuroendoscopy •  Ventriculoscopy

– Ventriculocisternostomie

Neuroendoscopy •  Ventriculoscopy

– Ventriculocisternostomie

– Shunt révision

Neuroendoscopy •  Ventriculoscopy

– Ventriculocisternostomie

– Shunt révision

– Biopsy

Neuroendoscopy •  Endoscopic biopsy

– Ventricular tumor

pineal tumor

Neuroendoscopy •  Endoscopic biopsy

– Ventricular tumor

– Paraventricular tumor

astrocytoma thalamic

Neuroendoscopy •  Endoscopic biopsy

– Ventricular tumor

– Paraventricular tumor

– Ventricular cyst

Neuroendoscopy •  Our choice: MINOP B Braun Aesculap

– Maneuverabilty trocars, instruments. – Lensscope with 90°-angled

Neuroendoscopy

Neuronavigation: Personal experience •  1996 MKM C.H.R. Citadelle Liège •  1999 Stealth Station Sofamor Danek •  2005 Stealth Tria Plus

Advanced Neuronavigation

•  New possibilities – StealthMerge: fusion of multiple data sets auto merge compatible with CT, MR, Pet scan

– Advanced 3D image – Tip extension

Advanced Neuronavigation •  Stealth Merge Ct scan MR Pet scan

Advanced Neuronavigation •  Stealth Merge

Advanced Neuronavigation •  Stealth Merge

Advanced Neuronavigation

Advanced Neuronavigation

Advanced Neuronavigation

•  Advanced 3D image

Advanced Neuronavigation

•  Advanced 3D image

Advanced Neuronavigation

•  Tip extension

Endoscopic

Navigation

Endoscopic Navigation

•  Surgical planning – Choice entry point and trajectory

Endoscopic Navigation

Endoscopic Navigation

•  Sure Trak endoscope tracking

Endoscopic Navigation

Endoscopic Navigation

Endoscopic Navigation

•  Illustration case 1

– 16 y.o. !, Parinaud’s syndrome – CT MR imaging: left thalamus mass hydrocephalus

– Pet FDG – methionine +

Endoscopic Navigation

•  Illustration case 1

Endoscopic Navigation

•  Illustration case 1

Endoscopic Navigation

•  Illustration case 1

Mass effect on Monro f. Left approach

Hydrocephalus aspect of Monro f.

Endoscopic Navigation

•  Illustration case 1

Endoscopic Navigation

•  Illustration case 1

Left biopsy

Endoscopic Navigation

•  Illustration case 1

Right ETV

Endoscopic Navigation

•  Illustration case 1

Endoscopic Navigation

•  Illustration case 1

J10 post ETV & biopsy Pre operative

Endoscopic Navigation

•  Illustration case 1 – Diagnosis: astrocytoma III – Treatement: conventional surgery astrocytoma III was confirmed

Endoscopic Navigation

•  Illustration case 2

– 21 y.o. ", recent diplopia – CT MR imaging: pineal tumor – Pet methionine: + – Blood α fetoproteine , βHCG: nl < 1 mUI/ml – CSF α fetoproteine: nl, βHCG: & 3 mUI/ml

Endoscopic Navigation

•  Illustration case 2

Advanced endoscopic biopsy

Advanced endoscopic biopsy

Endoscopic Navigation

•  Illustration case 2 – Treatment: chemotherapy & radiotherapy

2 cycles carbo/ etoposide / Ifosfamide 40 Gy radiotherapy

15 X 1.6 Gy ( GTV + 1.5cm + ventricules) = 24 Gy 10 X 1.6 Gy ( GTV + 1.5cm ) = 16 Gy

Endoscopic Navigation

•  Illustration case 2 – Treatment: chémothérapy & radiotherapy

Thanks

Endoscopic Navigation