A simple CT-scan-assisted craniotomy for small superficial cortical lesions in rural conditions

Abstract

Objective: Despite the excellence and modernization in medicine and neurosurgery, many countries, including Greece, still lack neuronavigational techniques, or hospital budget to cover the neuronavigation expenses. Therefore, help in the craniotomy design is needed, not only to safely remove a superficial lesion but also to help cut the expenses of neuronavigation in cases of economic challenges. The current study aims to present a new simple technique for craniotomy design for superficial cortical lesions. Materials and methods: The technique was applied as an urgent lifesaving method because of lacking frameless neuronavigation to 35 patients (19 males and 16 females) with superficial cortical lesions during a five-year period. This technique requires computer tomography (CT) scan, needle, and methylene blue dye. The patients were operated on at the neurosurgical department of Democritus University Hospital in Alexandroupolis, Greece. Results: From those 35 individuals, 16 had brain metastases, six patients had meningioma, six patients had glioma tumor, two had an abscess, two patients had arteriovenous malformation (AVM) and three patients had brain hematoma. The lesion was completely resected in all the 35 patients without any complications from the craniotomy or the colorant dye infusion. The accuracy of the technique compared with the frameless neuronavigation of the literature was extremely high. Conclusion: This is a simple and cheap technique for craniotomy design in case of superficial cortical lesions. It could be used in rural conditions or in hospitals with limited resources, as long as there is a computed tomography scan, craniotomy device and a dye stain.