Aim: The aim of this study was to investigate the effect of neuronavigation on the following parameters: "skin incision", "craniotomy", "intraoperative anatomical orientation", "dissection guiding", "localization of the pathological formation", "assessment of the degree of resection" and "duration of surgical procedure" in the resection of intracranial arteriovenous malformations (AVMs) and to specify the indications for application of neuronavigation in the surgical treatment of AVMs.
Methods: Five neuronavigation-assisted resections of intracranial AVMs were performed between March 2003 and December 2005 at the Clinic of Neurosurgery of St. I. Rilsky University Hospital, Medical University, Sofia. The female/male ratio in the series was 2:3 (40%:60%). The patients' mean age was 28.2 +/- 18.27 (range 10 to 56) years. The study was prospective in design. Patients were examined and followed in a standardized manner.
Results: Arteriovenous malformations were totally removed in all 5 cases of neuronavigation-assisted resections. We did not observe any morbidity or mortality associated with the method. Neuronavigation allowed precise localization and individual design of the skin incision and craniotomy. Neuronavigation facilitated the surgeon during intraoperative anatomical orientation. Dissection guiding, localization of the formation and assessment of the degree of resection were assessed as markedly useful. This resulted in reduced duration of surgery compared to conventional neurosurgery.
Conclusions: In AVMs resection neuronavigation optimizes surgical approach by visualizing the relationship ofAVMs to the skull and various critical anatomical structures. Deep vessel components and nidus margins, especially in the vicinity of the ventricles can be identified precisely. Neuronavigation can improve the early post-operative results in cerebral AVMs reducing operating time and blood loss.