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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