J Biomed Clin Res Volume 11 Number 2, 2018 DOI: 10.2478/jbcr-2018-0020 Original Articles BASIC NEURONAVIGATION OPTIONS FOR CORTICAL AND SUBCORTICAL BRAIN LESIONS SURGERY 0LODQ10ODGHQRYVNL Summary Nikolay V. Vasilev, 0ODGHQ(2YFKDURY &UDQLRPHWULFSRLQWVDUHHVVHQWLDOIRURULHQWLQJQHXURVXUJHRQV Iliya V. Valkov LQ WKHLU SUDFWLFH 8QGHUVWDQGLQJ WKH FRUUHODWLRQV RI WKHVH points help to manage any pathological lesion located on WKH FRUWLFDO VXUIDFH DQG VXEFRUWLFDOO\ 7KH EUDLQ VXOFL DQG Department of Neurology and J\UL VKRXOG EH LGHQWL¿HG EHIRUH FUDQLRWRP\ ,W LV GLI¿FXOW Neurosurgery, WR LGHQWLI\ WKHVH DQDWRPLFDO VWUXFWXUHV LQWUDRSHUDWLYHO\ Medical University – Pleven, DIWHUFUDQLRWRP\ ZLWKSUHFLVLRQ7KHPDLQSXUSRVHRIWKLV Bulgaria VWXG\ZDVWRFROOHFWDVPXFKLQIRUPDWLRQDVSRVVLEOHIURP WKHOLWHUDWXUHDQGRXUFOLQLFDOSUDFWLFHLQRUGHUWRIDFLOLWDWH WKH SODFHPHQW RI FUDQLRWRPLHV ZLWKRXW XVLQJ PRGHUQ QHXURQDYLJDWLRQV\VWHPV2SHUDWLYHUHSRUWVIURPWKHODVW¿YH \HDUVRQFUDQLDORSHUDWLRQVIRUFRUWLFDODQGVXEFRUWLFDOOHVLRQV ZHUHUHYLHZHG$OOWKHFUDQLRWRPLHVKDGEHHQSODQQHGXVLQJ IRXU PHWKRGV GHWHFWLRQ RI FUDQLRPHWULF SRLQWV FRPSXWHG WRPRJUDSK\ &7 VFDQVWRSRJUDPV PDJQHWLF UHVRQDQFH LPDJLQJ 05, VFDQVWRSRJUDPV DQG LQWUDRSHUDWLYH UHDO WLPHXOWUDVRQRJUDSK\ 86* 5HWURVSHFWLYHO\ZHDQDO\]HG FUDQLDORSHUDWLRQV2XUDQDO\VLVVKRZHGWKDWRSHUDWLQJ RQIRUFRUWLFDOOHVLRQVZHKDGIUHTXHQWO\XVHGWKH¿UVWDQG the second method mentioned above (118 patients), while LQ FDVHV RI VXEFRUWLFDO OHVLRQV ZH KDG XVHG FUDQLRPHWULF SRLQWV 05, VFDQVWRSRJUDPV DQG LQWUDRSHUDWLYH UHDOWLPH 86*DVPHWKRGVRIQHXURQDYLJDWLRQ SDWLHQWV 7KHVH UHVXOWV VKRZ WKDW FUDQLRPHWULF SRLQWV DUH HVVHQWLDO LQ ERWK QHXURVXUJLFDOSURFHGXUHV Key ZRUGV QHXURQDYLJDWLRQ FUDQLRPHWULF SRLQWV PRGHUQ QHXURQDYLJDWLRQ V\VWHPV &705, WRSRJUDPV LQWUDRSHUDWLYHUHDOWLPHXOWUDVRQRJUDSK\ 86* Introduction &RUUHVSRQGLQJ$XWKRU Craniometric points DUHFUDQLDOODQGPDUNVIURPZKLFK Milan N. Mladenovski FUDQLRPHWULFPHDVXUHPHQWVFDQEHWDNHQ 'HSDUWPHQWRI1HXURORJ\DQG Neurosurgery, /DQGPDUNVDUHDQDWRPLFDOVWUXFWXUHVXVHGDVSRLQWV Medical University – Pleven RI RULJLQ LQ ORFDWLQJ RWKHU DQDWRPLFDO VWUXFWXUHV Bulgaria Craniometric points are essential cranial points that 1, St. Kl. Ochridski Str. RULHQWDWH QHXURVXUJHRQV LQ SUDFWLFH 7KH EUDLQ VXOFL Pleven, 5800 DQGJ\ULFRXOGEHLGHQWL¿HGEHIRUHFUDQLRWRP\DQGWKLV Bulgaria PDNHVLWSRVVLEOHWRapproach any pathological lesion e-mail: [email protected] ORFDWHG RQ WKH FRUWLFDO VXUIDFH RU GHHS LQ WKH EUDLQ 3UHFLVH LGHQWL¿FDWLRQ RI WKHVH DQDWRPLFDO VWUXFWXUHV 5HFHLYHGOctober 04, 2018 LQWUDRSHUDWLYHO\ DIWHU FUDQLRWRP\ LV GLI¿FXOW VR WKH 5HYLVLRQUHFHLYHGNovember 07, 2018 PDLQREMHFWLYHRIWKLVVWXG\ZDVWRFROOHFWDVPXFK $FFHSWHGJanuary 17, 2019 © Medical University Pleven J Biomed Clin Res Volume 11 Number 2, 2018 LQIRUPDWLRQDVSRVVLEOHIURPWKHOLWHUDWXUHDQG Basic anthropological (craniometric) RXUFOLQLFDOSUDFWLFHWRIDFLOLWDWHWKHSODFHPHQW points RI FUDQLRWRPLHV ZLWKRXW XVLQJ PRGHUQ 6RPHRIWKHHVVHQWLDODQWKURSRORJLFDOSRLQWVDUH QHXURQDYLJDWLRQV\VWHPV YHU\ XVHIXO UHIHUHQFHV IRU SUHFLVH GHVFULSWLRQ ,Q WKH VWXG\ WKH WHUP ³QHXURQDYLJDWLRQ´ LV RI WKH DSSURDFK SODQQHG 7DEOH 7KH PDMRU QRWDV\QRQ\PIRULPDJHJXLGHGVXUJHU\ ,*6 DGYDQWDJHFRPHVIURPWKHLUIHDWXUH±WKH\FDQ DQG FRPSXWHUDVVLVWHGFRPSXWHUDLGHG VXUJHU\ EHVHHQERWKRQWKHKHDGDQGWKHLPDJLQJVWXGLHV &$6 WKHODWWHUWZREHLQJV\QRQ\PVIRUPRGHUQ VKRZLQJWKHLQWUDFUDQLDOSDWKRORJ\IRXQG>@ QHXURQDYLJDWLRQ V\VWHPV 1HXURQDYLJDWLRQ LV D WHFKQLTXH GHVLJQHG WR KHOS QHXURVXUJHRQV Topography of the main cerebral SUHFLVHO\ GHWHUPLQH WKH ORFDWLRQ RI YDULRXV sulci FRUWLFDO DQG VXEFRUWLFDO OHVLRQV E\ XVLQJ 7KH ODWHUDO DQG FHQWUDO ¿VVXUHV DUH WKH WZR PHWKRGVVXFKDVFUDQLRPHWULFSRLQWVFRPSXWHG PRVW LPSRUWDQW VXOFL RQ WKH FRQYH[ VXUIDFH RI tomography (CT), magnetic resonance imaging WKH FHUHEUDO KHPLVSKHUH VHUYLQJ DV UHIHUHQFHV 05, XOWUDVRQRJUDSK\ 86* LPDJHVHWF IRU ORFDOL]LQJ WKH RWKHU VXOFL DQG FRQYROXWLRQV RI WKH KHPLVSKHUHV +RZHYHU ZKHQ SODQQLQJ 0DWHULDOVDQG0HWKRGV FUDQLRWRPLHV GLVSODFHPHQW SURGXFHG E\ PDVV OHVLRQV VKRXOG EH DOVR FRQVLGHUHG VLQFH DIWHU 2SHUDWLYH UHSRUWV IURP WR ZHUH WKH SODQQHG FRUWLFDO H[SRVXUH J\UL DQG VXOFL UHYLHZHG RQ VXUJHULHV SHUIRUPHG DW WKH FDQEHIRXQGWREHQRWH[DFWO\DWWKHLUH[SHFWHG 1HXURVXUJHU\ &OLQLF 8QLYHUVLW\ 0XOWLSUR¿OH locations. +RVSLWDOIRU$FWLYH7UHDWPHQW³'U*6WUDQVNL´ $FFRUGLQJWRWKHVLPSOL¿HG.URQOHLQPHWKRG LQ 3OHYHQ 7ZR KXQGUHG QLQHW\¿YH FUDQLDO DKRUL]RQWDOOLQHLVGUDZQDWWKHOHYHORIWKHXSSHU RSHUDWLRQV IRU FRUWLFDO DQG VXEFRUWLFDO WXPRU RUELWDOHGJH )LJXUH lesions were reviewed. All craniotomies 7KHQWZRYHUWLFDOOLQHVDUHVXSHULPSRVHGWKH KDG EHHQ SODQQHG E\ XVLQJ IRXU PHWKRGV ¿UVWRQHWKURXJKWKHPLGSRLQWRIWKH]\JRPDWLF FUDQLRPHWULFSRLQWV&7VFDQVWRSRJUDPV05, DUFK DQG WKH VHFRQG WKURXJK WKH SRVWHULRU VFDQVWRSRJUDPV DQG LQWUDRSHUDWLYH UHDOWLPH ERUGHU RI WKH DXULFOH 7KH OLQH FRQQHFWLQJ WKH XOWUDVRQRJUDSK\ LQWHUVHFWLRQSRLQWEHWZHHQWKHKRUL]RQWDODQGWKH $OOLPDJHVZHUHSUHYLHZHGE\XVLQJ5DGL$QW ¿UVWYHUWLFDOOLQHZLWKWKHSRLQWZKHUHWKHVHFRQG ',&20 9LHZHU GHVLJQHG WR XVH UHVRXUFHV vertical line crosses the midline, corresponds to DV HI¿FLHQWO\ DV SRVVLEOH LQ YLHZLQJ PHGLFDO WKHSURMHFWLRQRIWKHFHQWUDOVXOFXV,IWKHDQJOH images. IRUPHG E\ WKH SURMHFWLRQ RI WKH FHQWUDO VXOFXV Table 1. Basic anthropological (craniometric) points and their characteristics Craniometric Characteristics points 1DVLRQ $SRLQWVLWXDWHGRIWKHEDVHRIWKHQRVHLQWKHPLGGOHRIWKHQDVRIURQWDOVXWXUH Bregma $SRLQWZKHUHWKHFRURQDODQGVDJLWWDOVXWXUHVMRLQRQWKHLQWDFWVNLQLWFDQEHGHWHUPLQHG DVWKHLQWHUVHFWLRQRIWKHWZRSHUSHQGLFXODUOLQHVGUDZQXSIURPWKHPLGSRLQWVRIERWK ]\JRPDWLFDUFKHV Lambda 7KHSRLQWZKHUHWKHODPEGRLGDQGVDJLWWDOVXWXUHVMRLQ ,QLRQ 7KLVSRLQWFRUUHVSRQGVWRWKHH[WHUQDORFFLSLWDOSURWXEHUDQFH Estephanon 6\PPHWULFDOSRLQWVRQERWKVLGHVRIWKHVNXOODWWKHSODFHZKHUHWKHFRURQDOVXWXUHFURVVHV WKHVXSHULRUWHPSRUDOOLQH Pterion $SSUR[LPDWHO\V\PPHWULFDOSRLQWVRQERWKVLGHVRIWKHVNXOOORFDWHGZKHUHWKHIURQWDO SDULHWDODQGWHPSRUDOERQHVMRLQWKHODUJHZLQJRIWKHVSKHQRLGERQH Asterion 6LPLODUWRWKHSUHYLRXVELODWHUDOSRLQWVDWWKHSODFHZKHUHWKHRFFLSLWDODQGSDULHWDOERQHV MRLQZLWKWKHPDVWRLGSDUWRIWKHWHPSRUDOERQH Glabella (g) ,WLVDFHSKDORPHWULFODQGPDUNWKDWLVMXVWVXSHULRUWRWKHQDVLRQ © Medical University Pleven Mladenovski M, et al. %DVLFQHXURQDYLJDWLRQRSWLRQVIRUFRUWLFDODQGVXEFRUWLFDOEUDLQ FRQQHFWLQJWKH]\JRPDWLFSURFHVVRIWKHIURQWDO ERQH ZLWK D SRLQW DW RI WKH OHQJWK RI WKH QDVLRQLQLRQGLVWDQFHVWDUWLQJIURPWKHQDVLRQ 7KHFHQWUDOVXOFXVFRUUHVSRQGVWRWKHXSSHUKDOI RIWKHOLQHFRQQHFWLQJWKHPLGOLQH FPEHKLQG it is the nasion-inion midpoint) and reaches the PLGGOHRIWKH]\JRPDWLFDUFK>@ Correlations between anthropological FUDQLRPHWULF SRLQWVDUHNQRZQDVFUDQLRPHWULF NH\ SRLQWV >@ 7KHVH DUH SRLQWV RI FUXFLDO LPSRUWDQFHWKDWKHOSWRLGHQWLI\WKHFRUWLFDOEUDLQ VXOFLDQGJ\UL 7DEOH CT brain scans/topograms Figure 1. Kronlein method CT head (brain) scan is the most common cranial $%KRUL]RQWDOOLQHDWWKHOHYHORIVXSHULRURUELWDOHGJH &' ¿UVW YHUWLFDO OLQH () VHFRQG YHUWLFDO OLQH +( LQYHVWLJDWLRQLQQHXURVXUJHU\$KHDG&7LVDV SURMHFWLRQ RI WKH FHQWUDO VXOFXV +* SURMHFWLRQ RI WKH important as a chest x-ray is in internal medicine. 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