Download - Advanced Neuro Endoscopy
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Advanced Endoscopic Navigation
M. Triffaux
Stealth Users Meeting 17 March 2006
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Neuroendoscopy • Introduction
Endoscopy
Navigation
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Neuroendoscopy • « Minimally Invasive Surgery »
Ventriculoscopy Pituitary Key hole surgery
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Neuroendoscopy • Ventriculoscopy
– Ventriculocisternostomie
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Neuroendoscopy • Ventriculoscopy
– Ventriculocisternostomie
– Shunt révision
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Neuroendoscopy • Ventriculoscopy
– Ventriculocisternostomie
– Shunt révision
– Biopsy
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Neuroendoscopy • Endoscopic biopsy
– Ventricular tumor
pineal tumor
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Neuroendoscopy • Endoscopic biopsy
– Ventricular tumor
– Paraventricular tumor
astrocytoma thalamic
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Neuroendoscopy • Endoscopic biopsy
– Ventricular tumor
– Paraventricular tumor
– Ventricular cyst
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Neuroendoscopy • Our choice: MINOP B Braun Aesculap
– Maneuverabilty trocars, instruments. – Lensscope with 90°-angled
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Neuroendoscopy
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Neuronavigation: Personal experience • 1996 MKM C.H.R. Citadelle Liège • 1999 Stealth Station Sofamor Danek • 2005 Stealth Tria Plus
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Advanced Neuronavigation
• New possibilities – StealthMerge: fusion of multiple data sets auto merge compatible with CT, MR, Pet scan
– Advanced 3D image – Tip extension
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Advanced Neuronavigation • Stealth Merge Ct scan MR Pet scan
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Advanced Neuronavigation • Stealth Merge
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Advanced Neuronavigation • Stealth Merge
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Advanced Neuronavigation
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Advanced Neuronavigation
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Advanced Neuronavigation
• Advanced 3D image
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Advanced Neuronavigation
• Advanced 3D image
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Advanced Neuronavigation
• Tip extension
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Endoscopic
Navigation
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Endoscopic Navigation
• Surgical planning – Choice entry point and trajectory
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Endoscopic Navigation
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Endoscopic Navigation
• Sure Trak endoscope tracking
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Endoscopic Navigation
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Endoscopic Navigation
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Endoscopic Navigation
• Illustration case 1
– 16 y.o. !, Parinaud’s syndrome – CT MR imaging: left thalamus mass hydrocephalus
– Pet FDG – methionine +
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Endoscopic Navigation
• Illustration case 1
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Endoscopic Navigation
• Illustration case 1
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Endoscopic Navigation
• Illustration case 1
Mass effect on Monro f. Left approach
Hydrocephalus aspect of Monro f.
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Endoscopic Navigation
• Illustration case 1
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Endoscopic Navigation
• Illustration case 1
Left biopsy
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Endoscopic Navigation
• Illustration case 1
Right ETV
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Endoscopic Navigation
• Illustration case 1
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Endoscopic Navigation
• Illustration case 1
J10 post ETV & biopsy Pre operative
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Endoscopic Navigation
• Illustration case 1 – Diagnosis: astrocytoma III – Treatement: conventional surgery astrocytoma III was confirmed
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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
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Endoscopic Navigation
• Illustration case 2
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Advanced endoscopic biopsy
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Advanced endoscopic biopsy
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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
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Endoscopic Navigation
• Illustration case 2 – Treatment: chémothérapy & radiotherapy
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Thanks
Endoscopic Navigation