University of Oulu

Neuronavigation in brain tumor surgery : clinical beta-phase of the Oulu Neuronavigator System

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Author: Schiffbauer, Hagen1
Organizations: 1University of Oulu, Faculty of Medicine, Department of Neurosurgery
Format: ebook
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 10.3 MB)
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Language: English
Published: 1999
Publish Date: 1999-01-22
Thesis type: Doctoral Dissertation
Defence Note: Academic Dissertation to be presented with the assent of the Faculty of Medicine, University of Münster, on October 14th, 1998.
Reviewer: Professor John P. Koivukangas
Professor Hansdetlef Wassmann


Interactive image-guided neurosurgery for the resection of brain tumors was developed within the last 10 years at different neurosurgical centers around the world to improve the safety of the surgery and the functional outcome of the patients. Since 1987, the Oulu Neuronavigator System, consisting mainly of a mechanical arm, visualization software, an ultrasound transducer and a computer, was developed at the Neurosurgical Research Unit, University of Oulu, Finland. It was the first system to incorporate the principle of the common surgical axis for visualization, including intraoperative ultrasonography. A precommercial version of the device was jointly developed with Elekta Ab, Stockholm, Sweden, as a public project under EUREKA and introduced into a clinical beta-phase trial in 1994 as the Leksell Index System™. A total of 19 operations were performed at the Oulu University Hospital between September 1994 and September 1996 for patients harboring different kinds of intracranial tumors, especially cerebral gliomas.

This thesis gives a comprehensive review of the literature from the roots of stereotaxy to the latest developments in interactive image-guided neurosurgery and discusses the advantages and disadvantages of the Leksell Index System™ with special reference to the clinical series that was performed at our institution. Future therapy strategies for the treatment of patients with cerebral gliomas, especially glioblastoma multiforme are envisioned, focusing on the further improvement of surgical interventions.

The clinical trial proved that the employed neuronavigator system is versatile and safe and that there are no adverse effects, complications or surgical mortality due to the device. It enabled the surgeon to plan smaller sized and better centered skin incisions and craniotomies and to approach the target lesion with less dissection of intact brain tissue. Despite more radical removal of lesions the overall invasiveness of the operation was decreased in 63.2% of the cases, the duration of the procedure was decreased in 78.9%, and the surgeon’s feeling of safety could be improved in 89.5% of the operations. Due to the use of intraoperative imaging (with ultrasound) the experience provides a unique basis for next generation neuronavigators and also for interventional MRI.

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Series: Acta Universitatis Ouluensis. D, Medica
ISSN-E: 1796-2234
ISBN: 951-42-5254-3
ISBN Print: 951-42-5128-8
Issue: 505
Copyright information: © University of Oulu, 1999. This publication is copyrighted. You may download, display and print it for your own personal use. Commercial use is prohibited.