Neuronavigation and NeuroEndoscopy Applications Stealth Users Medtronic Meeting 2006 Minimally Invasive Surgery Personal experience

1. Advanced
Endoscopic Navigation
M. Triffaux
Stealth Users Meeting 17 March 2006

2. Neuroendoscopy
• Introduction
Endoscopy
Navigation

3. Neuroendoscopy
• « Minimally Invasive Surgery »
Ventriculoscopy Pituitary Key hole surgery

4. Neuroendoscopy
• Ventriculoscopy
– Ventriculocisternostomie

5. Neuroendoscopy
• Ventriculoscopy
– Ventriculocisternostomie
– Shunt révision

6. Neuroendoscopy
• Ventriculoscopy
– Ventriculocisternostomie
– Shunt révision
– Biopsy

7. Neuroendoscopy
• Endoscopic biopsy
– Ventricular tumor
pineal tumor

8. Neuroendoscopy
• Endoscopic biopsy
– Ventricular tumor
– Paraventricular tumor
astrocytoma thalamic

9. Neuroendoscopy
• Endoscopic biopsy
– Ventricular tumor
– Paraventricular tumor
– Ventricular cyst

10. Neuroendoscopy
• Our choice: MINOP B Braun Aesculap
– Maneuverabilty trocars, instruments.
– Lensscope with 90°-angled

11. Neuroendoscopy

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

13. Advanced Neuronavigation
• New possibilities
– StealthMerge: fusion of multiple data sets
auto merge
compatible with
CT, MR, Pet scan
– Advanced 3D image
– Tip extension

14. Advanced Neuronavigation
• Stealth Merge
Ct scan MR Pet scan

15. Advanced Neuronavigation
• Stealth Merge

16. Advanced Neuronavigation
• Stealth Merge

17. Advanced Neuronavigation

18. Advanced Neuronavigation

19. Advanced Neuronavigation
• Advanced 3D image

20. Advanced Neuronavigation
• Advanced 3D image

21. Advanced Neuronavigation
• Tip extension

22. Endoscopic
Navigation

23. Endoscopic Navigation
• Surgical planning
– Choice entry point and trajectory

24. Endoscopic Navigation

25. Endoscopic Navigation
• Sure Trak
endoscope tracking

26. Endoscopic Navigation

27. Endoscopic Navigation

28. Endoscopic Navigation
• Illustration case 1
– 16 y.o. !, Parinaud’s syndrome
– CT MR imaging: left thalamus mass
hydrocephalus
– Pet FDG – methionine +

29. Endoscopic Navigation
• Illustration case 1

30. Endoscopic Navigation
• Illustration case 1

31. Endoscopic Navigation
• Illustration case 1
Mass effect on Monro f.
Left approach
Hydrocephalus aspect of Monro f.

32. Endoscopic Navigation
• Illustration case 1

33. Endoscopic Navigation
• Illustration case 1
Left biopsy

34. Endoscopic Navigation
• Illustration case 1
Right ETV

35. Endoscopic Navigation
• Illustration case 1

36. Endoscopic Navigation
• Illustration case 1
J10 post ETV & biopsyPre operative

37. Endoscopic Navigation
• Illustration case 1
– Diagnosis: astrocytoma III
– Treatement: conventional surgery
astrocytoma III was confirmed

38. 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

39. Endoscopic Navigation
• Illustration case 2

40. Advanced endoscopic biopsy

41. Advanced endoscopic biopsy

42. 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

43. Endoscopic Navigation
• Illustration case 2
– Treatment: chémothérapy & radiotherapy

44. Thanks
Endoscopic
Navigation