J Korean Neurosurg Soc.  2013 Mar;53(3):161-166. 10.3340/jkns.2013.53.3.161.

The Usefulness of Electromagnetic Neuronavigation in the Pediatric Neuroendoscopic Surgery

• Choi KY
• Seo BR
• Kim JH
• Kim SH
• Kim TS
• Lee JK

• KMID: 2190748
• DOI: http://doi.org/10.3340/jkns.2013.53.3.161

Abstract

OBJECTIVE
Neuroendoscopy is applied to various intracranial pathologic conditions. But this technique needs informations for the anatomy, critically. Neuronavigation makes the operation more safe, exact and lesser invasive procedures. But classical neuronavigation systems with rigid pinning fixations were difficult to apply to pediatric populations because of their thin and immature skull. Electromagnetic neuronavigation has used in the very young patients because it does not need rigid pinning fixations. The usefulness of electromagnetic neuronavigation is described through our experiences of neuroendoscopy for pediatric groups and reviews for several literatures.
METHODS
Between January 2007 and July 2011, nine pediatric patients were managed with endoscopic surgery using electromagnetic neuronavigation (AxiEM, Medtronics, USA). The patients were 4.0 years of mean age (4 months-12 years) and consisted of 8 boys and 1 girl. Totally, 11 endoscopic procedures were performed. The cases involving surgical outcomes were reviewed.
RESULTS
The goal of surgery was achieved successfully at the time of surgery, as confirmed by postoperative imaging. In 2 patients, each patient underwent re-operations due to the aggravation of the previous lesion. And one had transient mild third nerve palsy due to intraoperative manipulation and the others had no surgery related complication.
CONCLUSION
By using electromagnetic neuronavigation, neuroendoscopy was found to be a safe and effective technique. In conclusion, electromagnetic neuronavigation is a useful adjunct to neuroendoscopy in very young pediatric patients and an alternative to classical optical neuronavigation.

Keyword

Electromagnetic neuronavigation; Neuroendoscopy; Pediatrics

MeSH Terms

Humans
Magnets
Neuroendoscopy
Neuronavigation
Oculomotor Nerve Diseases
Pediatrics
Skull

Figure

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  Fig. 1 A : Fiducial markers. B : Mayfield frame as pinning fixation system. C : The setting of classical optical neuronavigation (0 : patient's head, 1 : infra-red camera, 2 : navigation pointer, 3 : reference frame).

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  Fig. 2 A : Resistration with EM neuronavigation system is performed in operation room13). White circle is EM coil. B : White circle is scalp array9). C : EM stylets13). EM : electromagnetic.

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  Fig. 3 A : A 8 cm sized interhemispheric multiloculated cystic lesion with hypogenesis of corpus callosum, right lateral ventricular dilatation on brain MRI (T2WI). B : Postoperative brain CT shows multiple pneumocephalus and decreased size of the cyst. C : Follow up brain MRI (T2WI) shows increased cyst compared with postoperative brain CT. D : Last follow up brain CT shows decreased cyst with inserted shunt proximal tip. T2WI : T2-weighted image

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  Fig. 4 A : A 6.5 cm sized cyst on right temporal lobe on brain CT. B : Last postoperative follow up brain CT shows that the cystic lesion disappeared completely.

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  Fig. 5 A : A 8 cm sized cystic lesion on left lateral ventricle on brain MRI (T2WI). B : Postoperative brain CT shows pneumocephalus on frontal horn on both lateral ventricles. C : Last follow up brain MRI (FLAIR) show decreased cystic lesion. T2WI : T2-weighted image.

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