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Präoperative fMRT-Diagnostik, Neuronavigation

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Funktionelle MRT in Psychiatrie und Neurologie

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Zusammenfassung

Die Neuronavigation spielt in der modernen Neurochirurgie eine wichtige Rolle und bietet die Möglichkeit der intraoperativen Visualisierung von Zielstrukturen, aber auch funktionellen Risikostrukturen. Nach Einführung in die Grundprinzipien der Navigation sowie der sog. multimodalen Neuronavigation soll hier detaillierter auf die präoperative fMRT- und DTI-Diagnostik sowie deren intraoperativen Einsatz eingegangen werden. Die intraoperative Visualisierung von funktionellen Strukturen ist bei manchen neurochirurgischen Eingriffen von essenzieller Bedeutung. Hervorzuheben ist hier die Resektion hirneigener Tumoren. Im neurochirurgischen Behandlungskonzept von Tumoren stellt die maximal sichere Tumorvolumenresektion den operativen Standard für intrazerebrale Läsionen dar. Was für benigne Prozesse unbestritten ist, wurde für nieder- und höhergradige hirneigene Tumore mit ihrem histopathologisch gesicherten infiltrativen Wachstumsmuster in der Literatur lange diskutiert (Keles et al. 2006; Pope et al. 2005), da eine Korrelation zwischen maximaler Tumorvolumenreduktion und verlängerter mittlerer Überlebenszeit der Patienten lange nicht sicher nachgewiesen werden konnte. Mittlerweile favorisiert die aktuelle Literatur jedoch auch für diese Art von Läsionen die maximale Tumorvolumenreduktion bei gleichzeitigem Erhalt der neurologischen Funktionalitäten als positiv prädiktiven Faktor für ein verbessertes Outcome der Patienten (Claus et al. 2005; Keles et al. 1999; Lacroix et al. 2001; Sanai u. Berger 2008; Stummer et al. 2006). Die Abgrenzung der Tumorgrenzen vom physiologischen Hirnparenchym stellt jedoch auch für den erfahrenen Neurochirurgen eine Herausforderung dar, da sich pathologisches und gesundes Gewebe auch unter Mikroskopvergrößerung oftmals nicht signifikant unterscheiden. Um dieses Ziel der maximal sicheren Resektion zu erreichen, macht sich die Neurochirurgie die sog. computergestützte multimodale Neuronavigation zunutze.

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Authors and Affiliations

  1. Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg, Baldingerstraße, 35033, Marburg

    Dr. Daniela Kuhnt, Miriam Helen Anna Bauer Dipl. Inform. & Prof. Dr. Christopher Nimsky

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  1. Dr. Daniela Kuhnt
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  2. Miriam Helen Anna Bauer Dipl. Inform.
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  3. Prof. Dr. Christopher Nimsky
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Editors and Affiliations

  1. Universitätsklinikum Aachen, Aachen

    Frank Schneider

  2. Forschungszentrum Jülich, Jülich

    Gereon R. Fink

  3. Uniklinik Köln, Köln

    Gereon R. Fink

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Kuhnt, D., Bauer, M., Nimsky, C. (2013). Präoperative fMRT-Diagnostik, Neuronavigation. In: Schneider, F., Fink, G.R. (eds) Funktionelle MRT in Psychiatrie und Neurologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29800-4_16

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  • DOI: https://doi.org/10.1007/978-3-642-29800-4_16

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