Search results

Clinical Neuroscience

SEPTEMBER 23, 2011

[The role of neuronavigation in the preoperative invasive evaluation and surgical treatment of drug resistant epilepsies]

ERÕSS Loránd

[For localizing the epileptogenic zone in cases of focal epilepsies detailed clinical investigations, imaging studies and electrophysiological methods are in use. In lesional epilepsies the intrapreoperatíve localization of the lesion and it’s location to the eloquent cortex is essential for the neurosurgeon. The development in image guided neurosurgery lead us to use neuronavigation systems to localize intracerebral lesions or functionally eloquent cortical areas or subcortical pathways during surgery. Neuronavigation brought changes in preoperatíve evaluation and in resective surgery in epilepsy as well. In this article we describe the basics of neuronavigation and enhance the advantages of the technique in epilepsy surgery during the presurgical evaluation with invasive electrodes, in resective surgery and DBS for epilepsy.]

Clinical Neuroscience

JANUARY 20, 2007

[APPLICATION OF FUNCTIONAL MR-IMAGES ACQUIRED AT LOW FIELD IN PLANNING OF NEUROSURGICAL OPERATION CLOSE TO AN ELOQUENT BRAIN AREA]

AUER Tibor, SCHWARCZ Attila, JANSZKY József, HORVÁTH Zsolt, KOSZTOLÁNYI Péter, DÓCZI Tamás

[Aim of the study - Presentation of functional MRI performed at low magnetic field (1 Tesla) for planning microsurgical operation in a patient suffering from tumor close to an eloquent brain area. Methods - Microsurgical removal navigated by frameless stereotaxy of an intrinsic tumor located in eloquent area is indicated if speech function is not damaged, i.e. exact localisation and relationship of the tumor and speech area can be defined. Before operation an optimized EPI based 2D sequence was applied to yield functional MR images. At the planning of the operation the paradigm used for the localization of the sensory language cortex contained passive listening to a text. Control investigations were performed one month postoperatively. A specific psychological test, as an additional investigation to estimate the accurate level of the sensory language function, was also conducted. Results - Low resolution (matrix of 64×64) functional MR images visualized sensory speech center and auditory cortex satisfactorily. The scans showed clearly that the Wernicke's region was situated just above the tumor (WHO grade II glioma), and this finding increased the safety of intraoperative localization and reduced the risk of morbidity. Control examinations revealed minimal decrease in sensory language function, however, it was not noticeable for either the patient or her surroundings. Conclusion - Optimized functional MR imaging performed at low magnetic field can support planning of neurosurgical operations and reduce the morbidity of microsurgical interventions.]

Clinical Neuroscience

JULY 30, 2006

[APPLICATION OF VERTEBROPLASTY, NEURONAVIGATION AND KYPHOPLASTY IN THE TREATMENT OF MULTIPLEX OSTEOPOROTIC VERTEBRAL FRACTURES - CASE REPORT]

KASÓ Gábor, HORVÁTH Zsolt, KÖVÉR Ferenc, EZER Erzsébet, DÓCZI Tamás

[Vertebroplasty is a therapeutic image-guided procedure, consisting of an injection of acrylic cement through a bone biopsy needle into a vertebral body. Main indication for vertebroplasty is painful vertebral body compression fracture due to osteoporosis. The procedure is an efficient mean with high succes in pain release and prevention of further collapse of the treated vertebrae; however, the technique does not allow to realign the spine. Kyphoplasty was designed to adress the kyphotic deformitiy. It involves the percutaneous placement of an inflatable bone tamp into a vertebral body (VB). Restoration of VB height and kyphosis correction is achieved by inflation of the tamp with contrast material liquid. After deflation a cavitiy is created that eases the cement application. The most modern way of guidance in spinal surgery is neuronavigation - the use of frameless stereotaxy. The system reformats patient-specific CT images acquired prior surgery, performs image fusion with intraoperative plain X-ray. Before the operation, the surgeon may create surgical plan and simulate advancement of a virtual instrument along one or more surgical trajectories. During surgery, the system tracks the position of specialized surgical instruments. All three modalities mentioned above have been applied in the treatment of our patient suffered from multiple osteoporotic vertebral body compression fractures. Using kyphoplasty an almost total VB height restoration could be achieved. The pain relief was more than 50% after both operation.]