Onscreen‐guided resection of extra‐axial and intra‐axial forebrain masses through registration of a variable‐suction tissue resection device with a neuronavigation system

Objectives To describe a novel surgical technique in which neuronavigation is used to guide a tissue resection device during excision of forebrain masses in locations difficult to visualize optically. Study design Short case series. Animals Six dogs and one cat with forebrain masses (five neoplastic, two nonneoplastic) undergoing excision with a novel tissue resection device and veterinary neuronavigation system. Methods The animals and resection instrument were coregistered to the neuronavigation system. Surgery was guided by real‐time onscreen visualization of the resection instrument position relative to the preoperative MR images. Surgical outcome was evaluated by calculating residual tumor volume according to postoperative MRI. Results The technique was technically simple and led to the collection of diagnostic tissue samples in all cases. Postoperative MRI was available in six cases, two with gross‐total resection, three with near‐total resection, and one with subtotal resection. Conclusion Neuronavigation‐guided resection of intra‐axial and extra‐axial brain masses with the resection device resulted in gross‐total or near‐total resection in five of six animals with tumors otherwise difficult to visualize. Risk of brain shift limited absolute reliance on navigation images. Clinical significance Real‐time neuronavigation assistance is a feasible method for guidance and successful resection of brain masses that are poorly visualized because of intra‐axial or deep location, tumor appearance, or hemorrhage.