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Zanier O, Theiler S, Mutten RD, Ryu SJ, Regli L, Serra C, Staartjes VE. TomoRay: Generating Synthetic Computed Tomography of the Spine From Biplanar Radiographs. Neurospine 2024; 21:68-75. [PMID: 38317547 PMCID: PMC10992629 DOI: 10.14245/ns.2347158.579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Computed tomography (CT) imaging is a cornerstone in the assessment of patients with spinal trauma and in the planning of spinal interventions. However, CT studies are associated with logistical problems, acquisition costs, and radiation exposure. In this proof-of-concept study, the feasibility of generating synthetic spinal CT images using biplanar radiographs was explored. This could expand the potential applications of x-ray machines pre-, post-, and even intraoperatively. METHODS A cohort of 209 patients who underwent spinal CT imaging from the VerSe2020 dataset was used to train the algorithm. The model was subsequently evaluated using an internal and external validation set containing 55 from the VerSe2020 dataset and a subset of 56 images from the CTSpine1K dataset, respectively. Digitally reconstructed radiographs served as input for training and evaluation of the 2-dimensional (2D)-to-3-dimentional (3D) generative adversarial model. Model performance was assessed using peak signal to noise ratio (PSNR), structural similarity index (SSIM), and cosine similarity (CS). RESULTS At external validation, the developed model achieved a PSNR of 21.139 ± 1.018 dB (mean ± standard deviation). The SSIM and CS amounted to 0.947 ± 0.010 and 0.671 ± 0.691, respectively. CONCLUSION Generating an artificial 3D output from 2D imaging is challenging, especially for spinal imaging, where x-rays are known to deliver insufficient information frequently. Although the synthetic CT scans derived from our model do not perfectly match their ground truth CT, our proof-of-concept study warrants further exploration of the potential of this technology.
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Affiliation(s)
- Olivier Zanier
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Sven Theiler
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Raffaele Da Mutten
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Seung-Jun Ryu
- Department of Neurosurgery, Daejeon Eulji University Hospital, Eulji University Medical School, Daejeon, Korea
| | - Luca Regli
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Carlo Serra
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Victor E. Staartjes
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zürich, University of Zürich, Zürich, Switzerland
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Kiesel B, Thomé CM, Weiss T, Jakola AS, Darlix A, Pellerino A, Furtner J, Kerschbaumer J, Freyschlag CF, Wick W, Preusser M, Widhalm G, Berghoff AS. Perioperative imaging in patients treated with resection of brain metastases: a survey by the European Association of Neuro-Oncology (EANO) Youngsters committee. BMC Cancer 2020; 20:410. [PMID: 32398144 PMCID: PMC7216695 DOI: 10.1186/s12885-020-06897-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/23/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Neurosurgical resection represents an important treatment option in the modern, multimodal therapy approach of brain metastases (BM). Guidelines for perioperative imaging exist for primary brain tumors to guide postsurgical treatment. Optimal perioperative imaging of BM patients is so far a matter of debate as no structured guidelines exist. METHODS A comprehensive questionnaire about perioperative imaging was designed by the European Association of Neuro-Oncology (EANO) Youngsters Committee. The survey was distributed to physicians via the EANO network to perform a descriptive overview on the current habits and their variability on perioperative imaging. Chi square test was used for dichotomous variables. RESULTS One hundred twenty physicians worldwide responded to the survey. MRI was the preferred preoperative imaging method (93.3%). Overall 106/120 (88.3%) physicians performed postsurgical imaging routinely including MRI alone (62/120 [51.7%]), postoperative CT (29/120 [24.2%]) and MRI + CT (15/120 [12.5%]). No correlation of postsurgical MRI utilization in academic vs. non-academic hospitals (58/89 [65.2%] vs. 19/31 [61.3%], p = 0.698) was found. Early postoperative MRI within ≤72 h after resection is obtained by 60.8% of the participants. The most frequent reason for postsurgical imaging was to evaluate the extent of tumor resection (73/120 [60.8%]). In case of residual tumor, 32/120 (26.7%) participants indicated to adjust radiotherapy, 34/120 (28.3%) to consider re-surgery to achieve complete resection and 8/120 (6.7%) to evaluate both. CONCLUSIONS MRI was the preferred imaging method in the preoperative setting. In the postoperative course, imaging modalities and timing showed high variability. International guidelines for perioperative imaging with special focus on postoperative MRI to assess residual tumor are warranted to optimize standardized management and adjuvant treatment decisions for BM patients.
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Affiliation(s)
- Barbara Kiesel
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Carina M Thomé
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Weiss
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Asgeir S Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Amélie Darlix
- Department of Medical Oncology, Institut Régional Du Cancer Montpellier, University of Montpellier, Montpellier, France
| | - Alessia Pellerino
- Department of Neuro-Oncology, University and City of Health and Science Hospital of Turin, Turin, Italy
| | - Julia Furtner
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | | | | | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Neurology Clinic & National Center for Tumor Disease, University of Heidelberg, Heidelberg, Germany
| | - Matthias Preusser
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria.,Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Anna S Berghoff
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. .,Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Wu X, Fels S, Paydarfar JA, Halter RJ, Sanchez CA, Kahng PW, Rees CA, Ponukumati AS, Eisen EA, Pastel DA, Borgard H, Lloyd JE. Multi-modal Framework for Image-guided Trans-oral Surgery with Intraoperative Imaging and Deformation Modeling. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:6975-6978. [PMID: 31947443 DOI: 10.1109/embc.2019.8857322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Treatment of throat cancers have improved due to minimally-invasive trans-oral approaches. Surgeons rely on preoperative imaging to guide their resection; however, large tissue deformations occur during trans-oral procedures due to placement of necessary retractors and laryngoscopes which hinders the surgeon's ability to accurately assess tumor extent and location of critical structures. We propose an image-guided framework utilizing intraoperative imaging and deformation modeling to improve surgeon accuracy and confidence. A CT-compatible laryngoscopy system previously developed was evaluated in this framework. Intraoperative images were acquired during laryngoscopy; force-sensing capabilities were enabled in the laryngoscope; and tracking of the scope and anatomic features was trialed. Tissue deformation and displacement were quantified and determined to be extensive, with values <; 4.6 cm in the tongue, <; 1.8 cm in bony structures, and <; 108.9 cm3 in airway volume change. Surgical navigation using intraoperative imaging and tracking was evaluated. Preliminary assessment of deformation modeling showed potential to supplement intraoperative imaging. Future work will involve streamlined integration of the components of this framework.
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Paydarfar JA, Wu X, Halter RJ. Initial experience with image-guided surgical navigation in transoral surgery. Head Neck 2018; 41:E1-E10. [PMID: 30556235 DOI: 10.1002/hed.25380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Surgical navigation using image guidance may improve the safety and efficacy of transoral surgery (TOS); however, preoperative imaging cannot be accurately registered to the intraoperative state due to deformations resulting from placement of the laryngoscope or retractor. This proof of concept study explores feasibility and registration accuracy of surgical navigation for TOS by utilizing intraoperative imaging. METHODS Four patients undergoing TOS were recruited. Suspension laryngoscopy was performed with a CT-compatible laryngoscope. An intraoperative contrast enhanced CT scan was obtained and registered to fiducials placed on the neck, face, and laryngoscope. RESULTS All patients were successfully scanned and registered. Registration accuracy within the pharynx and larynx was 1 mm or less. Target registration was confirmed by localizing endoscopic and surface structures to the CT images. Successful tracking was performed in all 4 patients. CONCLUSION For surgical navigation during TOS, although a high level of registration accuracy can be achieved by utilizing intraoperative imaging, significant limitations of the existing technology have been identified. These limitations, as well as areas for future investigation, are discussed.
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Affiliation(s)
- Joseph A Paydarfar
- Section of Otolaryngology, Audiology, and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, New Hampshire
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Xiaotian Wu
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Ryan J Halter
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
- Dartmouth College Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire
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Abstract
For a variety of head and neck cancers, specifically those of the oropharynx, larynx, and hypopharynx, minimally invasive trans-oral approaches have been developed to reduce perioperative and long-term morbidity. However, in trans-oral surgical approaches anatomical deformation due to instrumentation, specifically placement of laryngoscopes and retractors, present a significant challenge for surgeons relying on preoperative imaging to resect tumors to negative margins. Quantifying the deformation due to instrumentation is needed in order to develop predictive models of operative deformation. In order to study this deformation, we used a CT/MR-compatible laryngoscopy system in concert with intraoperative CT imaging. 3D models of preoperative and intraoperative anatomy were generated. Mandible and hyoid displacements as well as tongue deformations were quantified for eight patients undergoing diagnostic laryngoscopy. Across patients, we found on average 1.3 cm of displacement for these anatomic structures due to laryngoscope insertion. On average, the maximum displacement for certain tongue regions exceeded 4 cm. The anatomical deformations quantified here can serve as a reference for describing how the upper aerodigestive tract anatomy changes during instrumentation and may be helpful in developing predictive models of intraoperative upper aerodigestive tract deformation.
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Schichor C, Terpolilli N, Thorsteinsdottir J, Tonn JC. Intraoperative Computed Tomography in Cranial Neurosurgery. Neurosurg Clin N Am 2017; 28:595-602. [DOI: 10.1016/j.nec.2017.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stevens OAC, Hutchings J, Gray W, Vincent RL, Day JC. Miniature standoff Raman probe for neurosurgical applications. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:87002. [PMID: 27533445 DOI: 10.1117/1.jbo.21.8.087002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 07/11/2016] [Indexed: 06/06/2023]
Abstract
Removal of intrinsic brain tumors is a delicate process, where a high degree of specificity is required to remove all of the tumor tissue without damaging healthy brain. The accuracy of this process can be greatly enhanced by intraoperative guidance. Optical biopsies using Raman spectroscopy are a minimally invasive and lower-cost alternative to current guidance methods. A miniature Raman probe for performing optical biopsies of human brain tissue is presented. The probe allows sampling inside a conventional stereotactic brain biopsy system: a needle of length 200 mm and inner diameter of 1.8 mm. By employing a miniature stand-off Raman design, the probe removes the need for any additional components to be inserted into the brain. Additionally, the probe achieves a very low internal silica background while maintaining good collection of Raman signal. To illustrate this, the probe is compared with a Raman probe that uses a pair of optical fibers for collection. The miniature stand-off Raman probe is shown to collect a comparable number of Raman scattered photons, but the Raman signal to background ratio is improved by a factor of five at Raman shifts below ∼500 cm(−1). The probe’s suitability for use on tissue is demonstrated by discriminating between different types of healthy porcine brain tissue.
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Affiliation(s)
- Oliver A C Stevens
- University of Bristol, Interface Analysis Centre, H.H. Wills Physics Laboratory, Tyndall Avenue, Bristol BS8 1TL, United Kingdom
| | - Joanne Hutchings
- University of Bristol, Interface Analysis Centre, H.H. Wills Physics Laboratory, Tyndall Avenue, Bristol BS8 1TL, United KingdombBiophotonics Research Unit, Gloucestershire Hospitals NHS Foundation Trust, Gloucester GL1 3NN, United Kingdom
| | - William Gray
- Cardiff University, Neuroscience and Mental Health Research Institute, Schools of Medicine and Biosciences, Cardiff CF14 4XN, United Kingdom
| | - Rosa Louise Vincent
- Pfizer, 230 East Grand Avenue, South San Francisco, California 94080, United States
| | - John C Day
- University of Bristol, Interface Analysis Centre, H.H. Wills Physics Laboratory, Tyndall Avenue, Bristol BS8 1TL, United Kingdom
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Marreiros FMM, Rossitti S, Karlsson PM, Wang C, Gustafsson T, Carleberg P, Smedby Ö. Superficial vessel reconstruction with a multiview camera system. J Med Imaging (Bellingham) 2016; 3:015001. [PMID: 26759814 DOI: 10.1117/1.jmi.3.1.015001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/23/2015] [Indexed: 11/14/2022] Open
Abstract
We aim at reconstructing superficial vessels of the brain. Ultimately, they will serve to guide the deformation methods to compensate for the brain shift. A pipeline for three-dimensional (3-D) vessel reconstruction using three mono-complementary metal-oxide semiconductor cameras has been developed. Vessel centerlines are manually selected in the images. Using the properties of the Hessian matrix, the centerline points are assigned direction information. For correspondence matching, a combination of methods was used. The process starts with epipolar and spatial coherence constraints (geometrical constraints), followed by relaxation labeling and an iterative filtering where the 3-D points are compared to surfaces obtained using the thin-plate spline with decreasing relaxation parameter. Finally, the points are shifted to their local centroid position. Evaluation in virtual, phantom, and experimental images, including intraoperative data from patient experiments, shows that, with appropriate camera positions, the error estimates (root-mean square error and mean error) are [Formula: see text].
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Affiliation(s)
- Filipe M M Marreiros
- Linköping University, Center for Medical Image Science and Visualization, Campus US, Linköping SE-581 85, Sweden; Linköping University, Department of Science and Technology-Media and Information Technology, Campus Norrköping, Norrköping SE-601 74, Sweden; Linköping University, Department of Medical and Health Sciences, Campus US, Linköping SE-581 85, Sweden
| | - Sandro Rossitti
- County Council of Östergötland , Department of Neurosurgery, Linköping University, Campus US, Linköping SE-581 85, Sweden
| | - Per M Karlsson
- County Council of Östergötland , Department of Neurosurgery, Linköping University, Campus US, Linköping SE-581 85, Sweden
| | - Chunliang Wang
- Linköping University, Center for Medical Image Science and Visualization, Campus US, Linköping SE-581 85, Sweden; Royal Institute of Technology, School of Technology and Health, Alfred Nobels Allé 10, Huddinge SE-141 52, Sweden
| | | | - Per Carleberg
- XM Reality AB , Diskettgatan 11B, Linköping SE-583 35, Sweden
| | - Örjan Smedby
- Linköping University, Center for Medical Image Science and Visualization, Campus US, Linköping SE-581 85, Sweden; Linköping University, Department of Science and Technology-Media and Information Technology, Campus Norrköping, Norrköping SE-601 74, Sweden; Linköping University, Department of Medical and Health Sciences, Campus US, Linköping SE-581 85, Sweden; Royal Institute of Technology, School of Technology and Health, Alfred Nobels Allé 10, Huddinge SE-141 52, Sweden
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Kazanci A, Gurcan O, Gurcay A, Bozkurt I, Algin O, Turkoglu O, Bavbek M. A simple, safe and effective surface marking and targeting method combined with intraoperative ultrasonography for small subcortical intracranial lesions. J Neurosurg Sci 2015; 63:270-279. [PMID: 26173480 DOI: 10.23736/s0390-5616.16.03336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Accurately locating small subcortical brain lesions is very important for maximal surgical resection with minimal neurological damage. Intraoperative MRI has proved to be more precise than ultrasound, it is relatively expensive and is not available in all centers. Herein we describe a new, simple, safe and effective method for determining a small skin incision and craniotomy via skin staples combined with intraoperative ultrasonography to determine the margins, vascularity and residue of the lesion. METHODS Thirty-three patients with small subcortical lesions were admitted into the study. The maximum diameter of the lesions ranged between 18 and 30 mm. The depth of the lesion was described as the distance between the cortical surface and most outer point of the lesion. The mean of the depth of the lesions was 10.56 mm ranging between 3.3 and 18.7 mm. Multiple skin staples were used as irremovable skin markers. Before and after dural incision, ultrasound was used to assess the lesion size and location, its relationship with the surrounding tissue and the Doppler function to reveal the blood supply to the lesion. RESULTS In this study mean craniotomy diameter was 44 mm ranging between 32-55 mm. The location, extent, characteristics and adjacent tissue of the lesion were observed by high frequency ultrasonography during the operation. CONCLUSIONS We describe a simple, safe and effective method for determining a small skin incision and craniotomy combined with intraoperative ultrasound for small subcortical intracranial lesions for health center that does not have intraoperative MRI and navigation systems.
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Affiliation(s)
- Atilla Kazanci
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey -
| | - Oktay Gurcan
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Ahmet Gurcay
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Ismail Bozkurt
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Oktay Algin
- Department of Radiology, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Omer Turkoglu
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Murad Bavbek
- Department of Neurosurgery, School of Medicine, Yildirim Beyazit University, Ankara, Turkey
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Spena G, Panciani PP, Fontanella MM. Resection of supratentorial gliomas: the need to merge microsurgical technical cornerstones with modern functional mapping concepts. An overview. Neurosurg Rev 2014; 38:59-70; discussion 70. [PMID: 25328001 DOI: 10.1007/s10143-014-0578-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/22/2014] [Accepted: 06/22/2014] [Indexed: 01/09/2023]
Abstract
Although surgery is not curative for the majority of intracranial gliomas, radical resection has been demonstrated to influence survival and delay tumor progression. Because gliomas are very frequently located in eloquent or more generally critical areas, surgeons must always balance the maximizing resection with the need to preserve neurological function. In this overview, we tried to summarize the recent literature and our personal experience about (1) the benefits and limits of using preoperative anatomical and functional neuroimaging (anatomical MRI, DTI fiber tracking, and functional MRI), (2) the issues to consider in planning the surgical strategy, (3) the need to thoroughly understand microsurgical techniques that enable a maximal resection (subpial dissection, vascular manipulation, etc.), (4) the importance of individualizing surgical strategy especially in patients with gliomas in eloquent areas (the role of neuropsychological evaluation in redefining eloquent and non-eloquent areas), and (5) how to use intraoperative mapping techniques and understand why and when to use them. Through this paper, the reader should become more familiar with a comprehensive panel of techniques and methodologies but more importantly become aware that these recent technical advances facilitate a conceptual change from classical surgical paradigms toward a more patient-specific approach.
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Affiliation(s)
- Giannantonio Spena
- Neurosurgery Department, Spedali Civili and University of Brescia, Brescia, Italy,
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Xiao X, Wu Z, Zhang L, Jia G, Zhang J, Tang J, Meng G. Using the C7-T3 spinous processes as landmarks for the localization of thoracic spinal lesions: technique notes. Neurosurg Rev 2013; 37:147-52. [PMID: 24030754 DOI: 10.1007/s10143-013-0497-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 05/09/2013] [Accepted: 07/27/2013] [Indexed: 12/16/2022]
Abstract
The authors describe a method of using the C7-T3 spinous processes visualized on MRI as landmarks for localizing thoracic spinal lesions in 19 cases. This method included six steps. First, the "spinous process nearest to the lesion that was visible on the MRI image" was identified. Second, a dashed line was drawn on the image through the tip of the identified spinous process perpendicular to the skin surface. Third, two additional dashed lines parallel to the first dashed line were drawn from the upper and lower margins of the lesion. Fourth, the distances between the identified process and the two additional dashed lines were measured. Fifth, the same "spinous process nearest to the lesion" was identified by palpation and marked on the patient's skin. Sixth, the upper and lower margins of the lesion were marked on the skin according to the two distances measured in step 4. After the lesion was exposed, the deviations of the lesion margins were measured. All 19 cases of the thoracic spinal lesions were localized correctly using the C7-T3 spinous processes visualized on the MRI images as landmarks without any other evaluation methods. The deviation value for the localization of the tumor margin was 4.1 ± 1.47 mm. Using the C7-T3 spinous processes as landmarks is an accurate, simple, and economic method for lesion localization during thoracic spinal surgery.
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Affiliation(s)
- Xinru Xiao
- Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University, No.6, Tiantan Xili, Dongcheng District, 100050, Beijing, China,
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Purely subcortical tumors in eloquent areas: Awake surgery and cortical and subcortical electrical stimulation (CSES) ensure safe and effective surgery. Clin Neurol Neurosurg 2013; 115:1595-601. [DOI: 10.1016/j.clineuro.2013.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 11/17/2022]
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Andrews BT, Surek CC, Tanna N, Bradley JP. Utilization of computed tomography image-guided navigation in orbit fracture repair. Laryngoscope 2013; 123:1389-93. [PMID: 23649722 DOI: 10.1002/lary.23729] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 07/29/2012] [Accepted: 08/17/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Brian T Andrews
- Department of Plastic and Reconstructive Surgery, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
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Smolders LA, Voorhout G, van de Ven R, Bergknut N, Grinwis GCM, Hazewinkel HAW, Meij BP. Pedicle Screw-Rod Fixation of the Canine Lumbosacral Junction. Vet Surg 2012; 41:720-32. [DOI: 10.1111/j.1532-950x.2012.00989.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lucas A. Smolders
- Department of Clinical Sciences of Companion Animals; Faculty of Veterinary Medicine; Utrecht University; Utrecht; The Netherlands
| | - George Voorhout
- Division of Diagnostic Imaging; Faculty of Veterinary Medicine; Utrecht University; Utrecht; The Netherlands
| | - Renée van de Ven
- Department of Clinical Sciences of Companion Animals; Faculty of Veterinary Medicine; Utrecht University; Utrecht; The Netherlands
| | | | - Guy C. M. Grinwis
- Department of Pathobiology; Pathology Division, Faculty of Veterinary Medicine; Utrecht University; Utrecht; The Netherlands
| | - Herman A. W. Hazewinkel
- Department of Clinical Sciences of Companion Animals; Faculty of Veterinary Medicine; Utrecht University; Utrecht; The Netherlands
| | - Björn P. Meij
- Department of Clinical Sciences of Companion Animals; Faculty of Veterinary Medicine; Utrecht University; Utrecht; The Netherlands
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Validation of a hybrid Doppler ultrasound vessel-based registration algorithm for neurosurgery. Int J Comput Assist Radiol Surg 2012; 7:667-85. [PMID: 22447435 DOI: 10.1007/s11548-012-0680-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE We describe and validate a novel hybrid nonlinear vessel registration algorithm for intra-operative updating of preoperative magnetic resonance (MR) images using Doppler ultrasound (US) images acquired on the dura for the correction of brain-shift and registration inaccuracies. We also introduce an US vessel appearance simulator that generates vessel images similar in appearance to that acquired with US from MR angiography data. METHODS Our registration uses the minimum amount of preprocessing to extract vessels from the raw volumetric images. This prevents the removal of important registration information and minimizes the introduction of artifacts that may affect robustness, while reducing the amount of extraneous information in the image to be processed, thus improving the convergence speed of the algorithm. We then completed 3 rounds of validation for our vessel registration method for robustness and accuracy using (i) a large number of synthetic trials generated with our US vessel simulator, (ii) US images acquired from a real physical phantom made from polyvinyl alcohol cryogel, and (iii) real clinical data gathered intra-operatively from 3 patients. RESULTS Resulting target registration errors (TRE) of less than 2.5 mm are achieved in more than 90 % of the synthetic trials when the initial TREs are less than 20 mm. TREs of less than 2 mm were achieved when the technique was applied to the physical phantom, and TREs of less than 3 mm were achieved on clinical data. CONCLUSIONS These test trials show that the proposed algorithm is not only accurate but also highly robust to noise and missing vessel segments when working with US images acquired in a wide range of real-world conditions.
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Walter J, Reichart R, Waschke A, Kalff R, Ewald C. Palliative considerations in the surgical treatment of spinal metastases: evaluation of posterolateral decompression combined with posterior instrumentation. J Cancer Res Clin Oncol 2011; 138:301-10. [PMID: 22127369 DOI: 10.1007/s00432-011-1100-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Accepted: 11/10/2011] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the outcome of patients with spinal metastases, treated under palliative considerations by spinal decompression and sole posterior instrumentation, in respect to survival, neurological symptomatology, pain, ECOG grade, and Tomita's prognostic score (TPS). PATIENTS AND METHODS Fifty-seven consecutive patients with metastatic vertebral tumors were treated using a posterolateral approach for decompression combined with posterior instrumentation. Mean age was 58.6 years. In average, 3.4 vertebral segments were involved in instrumentation. RESULTS Preoperative mean TPS was 5.9. The majority of the patients (70.2%) presented with an ECOG grade ≤2. The distribution of the metastatic lesions that needed surgical treatment was: 7.8% cervical, 60.9% thoracical, and 31.3% lumbar. In 52.6% the tumor led to pathological vertebral fractures. Mean pain VAS scores improved significantly in all but one patient from 6.6 preoperatively to 3.1 postoperatively. Post-surgical Frankel grades decreased. Mean postoperative survival was 11.4 months. Ten patients survived until now. Forty-seven patients have died with a mean survival of 9 months. Complication rate was only 5.3% with two superficial wound infections and one seroma. Not a single case of posterior spinal instrumentation fatigue failure was detected. CONCLUSIONS Palliative surgical treatment for metastatic spinal tumors using a decompressive posterolateral approach combined with sole posterior instrumentation achieved convincing clinical results. All patients with intractable pain showed significant improvement postoperatively, and neurological deterioration was avoided. Since patients with spinal metastases enter the terminal stage of their disease, it is generally agreed that they require only palliative surgical treatments. Accordingly, spinal decompression and stabilization may be performed to improve the quality of the remaining life of cancer patients.
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Affiliation(s)
- Jan Walter
- Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Erlanger Allee 101, 07747, Jena, Germany.
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Shibata S, Kunieda T, Adachi H, Ueno Y, Kohara N, Sakai N. Preoperative localization of intracranial lesions with MRI using marking pills. Clin Neurol Neurosurg 2011; 113:854-8. [PMID: 21764508 DOI: 10.1016/j.clineuro.2011.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 04/15/2011] [Accepted: 06/13/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe a simple technique for preoperative surface localization of intracranial lesions. METHODS 11 pills in total, including Alfarol (alfacalcidol) capsules, were affixed to a phantom with adhesive tape and a MRI scan was performed. The visibility of the pills and any spatial errors in determining their locations were evaluated. Between June 2006 and April 2009, we employed Alfarol capsules as a skin marker in MRI in clinical surgical cases. RESULTS Alfarol capsules, whose actual size is 5.6 mm in diameter, were identified as a hyperintense spot at a size of 4.2, 4.2, and 4.5mm in diameter in T1-weighted, T2-weighted, and FLAIR (fluid attenuated inversion recovery) sequence images, respectively. The size discrepancies were within 1.4 mm. The average spatial errors were 0.7, 0.6, and 0.7 mm in T1-weighted, T2-weighted, and FLAIR sequence images, respectively. Other pills were not identified in the MRI scans. During this 35-month period, 8 patients underwent preoperative MRI-guided localization at our institution. There were 5 men and 3 women in whom 8 biopsies were performed. In all cases, the result of the biopsy was positive and useful for the treatment that followed. No perioperative complications were encountered. CONCLUSION Alfarol capsule can be used as an external skin marker. Our simple and inexpensive method is a useful addition to preoperative evaluation of superficial intracranial lesions.
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Affiliation(s)
- Sumiya Shibata
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Japan.
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Lobão CAF, Nogueira J, Souto AADD, Oliveira JAD. Cerebral biopsy: comparison between frame-based stereotaxy and neuronavigation in an oncology center. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 67:876-81. [PMID: 19838521 DOI: 10.1590/s0004-282x2009000500018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 07/29/2009] [Indexed: 11/21/2022]
Abstract
Treatment of intracranial tumoral lesions is related to its correct histological diagnostic. We present a retrospective analysis of 32 patients submitted to 36 cerebral biopsies using neuronavigation and 44 patients using frame-based stereotaxy. Mean age was 46.6 and 49.3 years old respectively. Sex distribution in both groups was 50% for each. Most of lesions were lobar in both groups. Diagnostic yielding was 91.7% and 83.4%, respectively (p=0.26). We found in the postoperative CT scans intracranial hemorrhages in 13.8% cases of the first group and 9.8% cases in the second. Most of them were mild post-operative hemorrages in the biopsy site. There was one death related to the procedure in each group. Astrocytomas and metastatic adenocarcinomas were the most frequent diagnosis. Diagnostic yielding and the number of postoperative hemorrhage and death were similar on both groups and the same found in the literature.
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Kim JW, Lee SH, Son YJ, Yang HJ, Chung YS, Jung HW. Mobile computed tomography : early experience in Korea. J Korean Neurosurg Soc 2010; 48:31-6. [PMID: 20717509 DOI: 10.3340/jkns.2010.48.1.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Revised: 05/26/2010] [Accepted: 06/21/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE With improved technology, the values of intraoperative computed tomography (iCT) have been reevaluated. We describe our early clinical experience with a mobile CT (mCT) system for iCT and discuss its clinical applications, advantages and limitations. METHODS Compared with intraoperative magnetic resonance imaging, this mCT system has no need for major reconstruction of a preexisting operating room for shielding, or for specialized instruments or equipment. Patients are placed on a radiolucent head clamp that fits within the gantry. Because it consists simply of a scanner and a workstation, it can be moved between locations such as an operating room, an intensive care unit (ICU) or an emergency room without difficulty. Furthermore, it can achieve nearly all types of CT scanning procedures such as enhancement, temporal bone imaging, angiography and three-dimensional reconstruction. RESULTS For intracranial surgery, mCT can be used for intraoperative real-time neuronavigation by interacting with preoperative images. It can also be used for intraoperative confirmation of the extent of resection of intracranial lesions and for immediate checks for preventing intraoperative unexpected accidents. Therefore, the goals of maximal resection or optimal treatment can be achieved without any guesswork. Furthermore, mCT can achieve improved patient care with safety and faster diagnosis for patients in an ICU who might be subjected to a ventilator and/or various monitoring devices. CONCLUSION Our initial experience demonstrates that mCT with high-quality imaging offers very useful information in various clinical situations.
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Affiliation(s)
- Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
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Harel R, Angelov L. Spine metastases: current treatments and future directions. Eur J Cancer 2010; 46:2696-707. [PMID: 20627705 DOI: 10.1016/j.ejca.2010.04.025] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 04/08/2010] [Accepted: 04/28/2010] [Indexed: 11/17/2022]
Abstract
Spinal metastases are the most frequently encountered spinal tumour and can affect up to 50% of cancer patients. Both the incidence and prevalence of metastases are thought to be rising due to better detection and treatment options of the systemic malignancy resulting in increased patient survival. Further, the development and access to newer imaging modalities have resulted in easier screening and diagnosis of spine metastases. Current evidence suggests that pain, neurological symptoms and quality of life are all improved if patients with spine metastases are treated early and aggressively. However, selection of the appropriate therapy depends on several factors including primary histology, extent of the systemic disease, existing co-morbidities, prior treatment modalities, patient age and performance status, predicted life expectancy and available resources. This article reviews the currently available therapeutic options for spinal metastases including conventional external beam radiation therapy, open surgical decompression and stabilisation, vertebral augmentation and other minimally invasive surgery (MIS) options, stereotactic spine radiosurgery, bisphosphonates, systemic radioisotopes and chemotherapy. An algorithm for the management of spine metastases is also proposed. It outlines a multidisciplinary and integrated approach to these patients and it is hoped that this along with future advances and research will result in improved patient care and outcomes.
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Affiliation(s)
- Ran Harel
- Center for Spine Health, Cleveland Clinic, 9500 Euclid Avenue, S-80, Cleveland, OH 44195, USA
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22
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CT–MR image data fusion for computer-assisted navigated surgery of orbital tumors. Eur J Radiol 2010; 73:224-9. [DOI: 10.1016/j.ejrad.2008.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 11/02/2008] [Accepted: 11/05/2008] [Indexed: 11/23/2022]
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Upadhyay UM, Golby AJ. Role of pre- and intraoperative imaging and neuronavigation in neurosurgery. Expert Rev Med Devices 2009; 5:65-73. [PMID: 18095898 DOI: 10.1586/17434440.5.1.65] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advances in neuroimaging acquisition, computing and image processing have enabled neurosurgeons to use radiological imaging to guide both preoperative planning and intraoperative guidance. In preoperative planning, imaging may be used to evaluate surgical risks, choose the best method of intervention and select the safest surgical approach. Neuronavigation may be useful in designing the surgical flap and alerting the surgeon of surrounding anatomy. Finally, intraoperative imaging may be used to define brain shift associated with the resection of intracranial lesions, assist in more complete lesion resection, and monitor for certain intraoperative complications. In the following review, we briefly examine the history of neuroradiology for neurosurgery, neuronavigation and intraoperative imaging and trace their advances to current systems in use. We will also highlight new experimental applications of neuroimaging that are currently being refined.
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Affiliation(s)
- Urvashi M Upadhyay
- Department of Neurosurgery, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA 02115, USA.
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Transsulcal approach supported by navigation-guided neurophysiological monitoring for resection of paracentral cavernomas. Clin Neurol Neurosurg 2009; 111:69-78. [DOI: 10.1016/j.clineuro.2008.09.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Revised: 08/30/2008] [Accepted: 09/04/2008] [Indexed: 11/17/2022]
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Heuer GG, Zaghloul KA, Jaggi JL, Baltuch GH. Use of an integrated platform system in the placement of deep brain stimulators. Neurosurgery 2008; 62:245-7; discussion 247-8. [PMID: 18424992 DOI: 10.1227/01.neu.0000317399.00842.fa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The placement of deep brain stimulator leads requires a great deal of technology and equipment. We describe our 25-month experience with an integrated platform system, the StimPilot (Medtronic Inc., Minneapolis, MN), for the placement of deep brain stimulator leads. The platform consists of a neuronavigation station, microdrive control, and microelectrode recording display and control. This platform is run from a laptop-sized portable control unit. The unit was used in 147 patients for the placement of 262 leads. Leads were placed into the subthalamic nucleus, ventral intermediate nucleus, globus pallidus interna, and anterior thalamic nucleus. One patient required replacement of one lead during this time frame, with successful reimplantation. No system failures occurred.
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Affiliation(s)
- Gregory G Heuer
- Center for Functional and Restorative Neurosurgery, Penn Neurological Institute, Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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Reinertsen I, Lindseth F, Unsgaard G, Collins DL. Clinical validation of vessel-based registration for correction of brain-shift. Med Image Anal 2007; 11:673-84. [PMID: 17681484 DOI: 10.1016/j.media.2007.06.008] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 05/04/2007] [Accepted: 06/25/2007] [Indexed: 11/25/2022]
Abstract
In this paper, we have tested and validated a vessel-based registration technique for correction of brain-shift using retrospective clinical data from five patients: three patients with brain tumors, one patient with an aneurysm and one patient with an arteriovenous malformation. The algorithm uses vessel centerlines extracted from segmented pre-operative MRA data and intra-operative power Doppler ultrasound images to compute first a linear fit and then a thin-plate spline transform in order to achieve non-linear registration. The method was validated using (i) homologous landmarks identified in the original data, (ii) selected vessels, excluded from the fitting procedure and (iii) manually segmented, non-vascular structures. The tracking of homologous landmarks show that we are able to correct the deformation to within 1.25 mm, and the validation using excluded vessels and anatomical structures show an accuracy of 1mm. Pre-processing of the data can be completed in 30 s per dataset, and registrations can be performed in less than 30s. This makes the technique well suited for intra-operative use.
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Affiliation(s)
- I Reinertsen
- Montreal Neurological Institute (MNI), McGill University, Montréal, Canada.
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Reinertsen I, Descoteaux M, Siddiqi K, Collins DL. Validation of vessel-based registration for correction of brain shift. Med Image Anal 2007; 11:374-88. [PMID: 17524702 DOI: 10.1016/j.media.2007.04.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Revised: 04/11/2007] [Accepted: 04/11/2007] [Indexed: 11/25/2022]
Abstract
The displacement and deformation of brain tissue is a major source of error in image-guided neurosurgery systems. We have designed and implemented a method to detect and correct brain shift using pre-operative MR images and intraoperative Doppler ultrasound data and present its validation with both real and simulated data. The algorithm uses segmented vessels from both modalities, and estimates the deformation using a modified version of the iterative closest point (ICP) algorithm. We use the least trimmed squares (LTS) to reduce the number of outliers in the point matching procedure. These points are used to drive a thin-plate spline transform to achieve non-linear registration. Validation was completed in two parts. First, the technique was tested and validated using realistic simulations where the results were compared to the known deformation. The registration technique recovered 75% of the deformation in the region of interest accounting for deformations as large as 20 mm. Second, we performed a PVA-cryogel phantom study where both MR and ultrasound images of the phantom were obtained for three different deformations. The registration results based on MR data were used as a gold standard to evaluate the performance of the ultrasound based registration. On average, deformations of 7.5 mm magnitude were corrected to within 1.6 mm for the ultrasound based registration and 1.07 mm for the MR based registration.
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Affiliation(s)
- I Reinertsen
- Montreal Neurological Institute (MNI), McGill University, Montréal, Canada.
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Is the image guidance of ultrasonography beneficial for neurosurgical routine? ACTA ACUST UNITED AC 2007; 67:579-87; discussion 587-8. [PMID: 17512324 DOI: 10.1016/j.surneu.2006.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 07/13/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intraoperative US has been widely used in neurosurgical procedures. However, images are often difficult to read. In the present study, we evaluate whether the image guidance of ultrasonography is helpful for the interpretation of US scans. METHODS Twenty-nine patients with tumor were operated on with the aid of intraoperative US from January to June 2005. Image-guided sonography was used in 13 cases and nonnavigated US technology in the remaining cases. We compared the 2 technologies retrospectively. RESULTS Although image quality was good in most cases, orientation remained difficult in 8 of the 16 patients where conventional sonography was used. With the aid of image fusion for navigated sonography, the orientation was judged superior to nonnavigated US. CONCLUSION In our experience, integration of the US into the navigation system facilitates anatomical understanding. Thus, we feel that this technology is beneficial for neurosurgical routine.
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Nemec SF, Donat MA, Mehrain S, Friedrich K, Krestan C, Matula C, Imhof H, Czerny C. CT–MR image data fusion for computer assisted navigated neurosurgery of temporal bone tumors. Eur J Radiol 2007; 62:192-8. [PMID: 17229539 DOI: 10.1016/j.ejrad.2006.11.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Revised: 11/19/2006] [Accepted: 11/21/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To demonstrate the value of multi detector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the preoperative work up of temporal bone tumors and to present, especially, CT and MR image fusion for surgical planning and performance in computer assisted navigated neurosurgery of temporal bone tumors. MATERIALS AND METHODS Fifteen patients with temporal bone tumors underwent MDCT and MRI. MDCT was performed in high-resolution bone window level setting in axial plane. The reconstructed MDCT slice thickness was 0.8 mm. MRI was performed in axial and coronal plane with T2-weighted fast spin-echo (FSE) sequences, un-enhanced and contrast-enhanced T1-weighted spin-echo (SE) sequences, and coronal T1-weighted SE sequences with fat suppression and with 3D T1-weighted gradient-echo (GE) contrast-enhanced sequences in axial plane. The 3D T1-weighted GE sequence had a slice thickness of 1mm. Image data sets of CT and 3D T1-weighted GE sequences were merged utilizing a workstation to create CT-MR fusion images. MDCT and MR images were separately used to depict and characterize lesions. The fusion images were utilized for interventional planning and intraoperative image guidance. The intraoperative accuracy of the navigation unit was measured, defined as the deviation between the same landmark in the navigation image and the patient. RESULTS Tumorous lesions of bone and soft tissue were well delineated and characterized by CT and MR images. The images played a crucial role in the differentiation of benign and malignant pathologies, which consisted of 13 benign and 2 malignant tumors. The CT-MR fusion images supported the surgeon in preoperative planning and improved surgical performance. The mean intraoperative accuracy of the navigation system was 1.25 mm. CONCLUSION CT and MRI are essential in the preoperative work up of temporal bone tumors. CT-MR image data fusion presents an accurate tool for planning the correct surgical procedure and is a benefit for the operational results in computer assisted navigated neurosurgery of temporal bone tumors.
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Affiliation(s)
- Stefan Franz Nemec
- Department of Radiology/Osteology, Medical University Vienna, Waehringerguertel 18-20, A-1090 Vienna, Austria.
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Salas S, Brimacombe M, Schulder M. Stereotactic accuracy of a compact intraoperative MRI system. Stereotact Funct Neurosurg 2006; 85:69-74. [PMID: 17167234 DOI: 10.1159/000097921] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the stereotactic accuracy of the PoleStar N-20, a compact intraoperative magnetic resonance imaging (iMRI) system, based on a 0.15-Tesla (T) magnet. METHODS An MRI-compatible phantom was scanned after being positioned in both the center of the magnetic field (COF) and the periphery of the field (POF) of the PoleStar N-20 magnet. Scans were acquired at various slice thicknesses in 3 sequences: T(1) weighted, T(2) weighted and Esteady (reversed fast imaging with steady-state precession, also known as 'PSIF'). The distance between the actual location of the probe tip in space and the location of the target on the image was measured on the axial, coronal, and sagittal planes for 9 points on each image. Each measurement was repeated 3 times. We also compared the structural features of the PoleStar N-20 to those of its predecessor. RESULTS T(1)-weighted scans yielded the most accurate measurements. There was no statistically significant difference between scans acquired at thicknesses of 2, 3, 4 and 8 mm; all were accurate for clinical purposes. Comparison of COF with POF measurements using T(1)-weighted scans did not demonstrate a statistically significant difference in accuracy. CONCLUSIONS The PoleStar N-20 0.15-T iMRI system provides surgical navigation that is at least as accurate as the first generation model of this system, which employed a 0.12-T magnet. Further analysis of stereotactic accuracy on clinical cases using the PoleStar N-20 is needed to confirm that these results will bear out in surgical reality.
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Affiliation(s)
- Sussan Salas
- Department of Neurological Surgery, New Jersey Medical School, Newark, NJ 07103, USA
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Sorensen SP, Chow PE, Kriminski S, Medin PM, Solberg TD. Image-guided radiotherapy using a mobile kilovoltage x-ray device. Med Dosim 2006; 31:40-50. [PMID: 16551528 DOI: 10.1016/j.meddos.2005.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2005] [Indexed: 10/24/2022]
Abstract
A mobile isocentric C-arm kilovoltage imager has been evaluated as a potential tool for image-guided radiotherapy. The C-arm is equipped with an amorphous silicon flat panel for high-quality image acquisition. Additionally, the device is capable of cone beam computed tomography (CT) and volumetric reconstruction. This is achieved through the application of a modified Feldkamp algorithm with acquisition over a 180 degrees scan arc. The number of projections can be varied from 100 to 1000, resulting in a reconstructed volume 20 cm in diameter by 15-cm long. While acquisition time depends upon number of projections, acceptable quality images can be obtained in less than 60 seconds. Image resolution and contrast of cone-beam phantom images have been compared with images from a conventional CT scanner. The system has a spatial resolution of > or = 10 lp/cm and resolution is approximately equal in all 3 dimensions. Conversely, subject contrast is poorer than conventional CT, compromised by the increased scatter and underlying noise inherent in cone beam reconstruction, as well as the absence of filtering prior to reconstruction. The mobility of the C-arm makes it necessary to determine the C-arm position relative to the linear accelerator isocenter. Two solutions have been investigated: (1) the use of fiducial markers, embedded in the linac couch, that can subsequently be registered in the image sets; and (2), a navigation approach for infrared tracking of the C-arm relative to the linac isocenter. Observed accuracy in phantom positioning ranged from 1.0 to 1.5 mm using the navigation approach and 1.5 to 2.5 mm using the fiducial-based approach. As part of this work, the impact of respiratory motion on cone-beam image quality was evaluated, and a scheme for retrospective gating was devised. Results demonstrated that kilovoltage cone beam CT provides spatial integrity and resolution comparable to conventional CT. Cone-beam CT studies of patients undergoing radiotherapy have demonstrated acceptable soft tissue contrast, allowing assessment of daily changes in target anatomy. Of the 2 approaches developed to register images to the linac isocenter, the navigation method demonstrated superior accuracy for daily patient positioning relative to the fiducial-based method. Finally, significant image degradation due to respiratory motion was observed. It was demonstrated that this could be improved by correlating the acquisition of individual 2D projections with respiration for retrospective reconstruction of phase-based volumetric datasets.
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Affiliation(s)
- Stephen P Sorensen
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Litofsky NS, Bauer AM, Kasper RS, Sullivan CM, Dabbous OH. Image-guided resection of high-grade glioma: patient selection factors and outcome. Neurosurg Focus 2006; 20:E16. [PMID: 16709021 DOI: 10.3171/foc.2006.20.4.10] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECT In patients with glioma, image-guided surgery helps to define the radiographic limits of the tumor to maximize safety and the extent of resection while minimizing damage to eloquent brain tissue. The authors hypothesize that image-guided resection (IGR) techniques are associated with improved outcomes in patients with malignant glioma. METHODS Data recorded in 486 patients enrolled in the Glioma Outcomes Project were analyzed in this study. Demographic data and outcomes in patients who underwent IGR were compared with those in patients who underwent resection without IGR. Univariate analysis performed with chi-square testing was used to compare patient presentation, tumor characteristics, and death rates. Multivariate logistic regression was used to predict various outcome parameters. Patients who underwent IGR were younger and had smaller, lower-grade tumors than those in whom IGR was not performed. They were more likely to present with seizure and normal consciousness. Unexpectedly, gross-total resection was performed in significantly fewer patients with IGR than in individuals without IGR. Patients with IGR were more likely to be discharged home with the ability to live independently, and they had a shorter duration of hospital stay than patients without IGR. Survival was significantly longer in patients who underwent IGR, but multivariate analysis showed that glioblastoma multiforme (GBM) and age accounted for these observations. CONCLUSIONS Selection bias occurs regarding patients who receive IGR; these biases include younger age, presentation with seizure and normal level of consciousness, tumor diameter less than 4 cm, and non-GBM on histopathological studies. Outcome appears to be improved in patients who undergo IGRs of high-grade gliomas. It is unclear if these improved outcomes are due to the selection of a more favorable patient population or to the IGR techniques themselves. It is likely that the full potential of image guidance in glioma surgery will not be realized until it is applied to a wider range of patients.
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Affiliation(s)
- N Scott Litofsky
- Division of Neurosurgery, University of Missouri-Columbia School of Medicine, Columbia, Missouri 65212, USA.
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Goodkin R, Laska LL. Wrong disc space level surgery: medicolegal implications. ACTA ACUST UNITED AC 2004; 61:323-41; discussion 341-2. [PMID: 15031066 DOI: 10.1016/j.surneu.2003.08.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2003] [Accepted: 08/18/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Operating the wrong disc level for herniated disc disease is a rarely reported complication. However, it is considered by many a breach in the standard of care. It is not unusual for litigation to result. Sixty-nine cases of wrong disc space level surgery were identified; 68 cases were the subject of lawsuits. METHODS Sixty-five lawsuit outcomes were published in a national monthly newsletter of malpractice cases, Medical Malpractice Verdicts, Settlements and Experts. Two cases came from medicolegal review, one case from a news article, and one case for which no claim was made. RESULTS Thirty-seven cases were settled. A plaintiff verdict was rendered in 18 cases and a defense verdict in 13 cases (42% of the cases that were decided by a jury). CONCLUSIONS The authors summarize steps to reduce the incidence of this misadventure. The authors recommend that the patient be advised of this potential and the patient be informed of the risk factors when special circumstances exist.
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Affiliation(s)
- Robert Goodkin
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington 98195, USA
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Vessel Driven Correction of Brain Shift. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION – MICCAI 2004 2004. [DOI: 10.1007/978-3-540-30136-3_27] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Zhao JZ, Wang S, Wang DJ, Wang R, Sui DL, Han XD, Cao Y, Lu Z, Zhao YL. Application of Frameless Stereotaxy in Craniotomy Procedures: Clinical Evaluation. ACTA ACUST UNITED AC 2003. [DOI: 10.1097/00013414-200303000-00005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Solomon SB, Dickfeld T, Calkins H. Real-time cardiac catheter navigation on three-dimensional CT images. J Interv Card Electrophysiol 2003; 8:27-36. [PMID: 12652174 DOI: 10.1023/a:1022379612437] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Targets for ablation of atrial fibrillation, atrial flutter, and non-idiopathic ventricular tachycardia are increasingly being selected based on anatomic considerations. Because fluoroscopy provides only limited information about the relationship between catheter positions and cardiac structures, and is associated with radiation risk, other approaches to mapping may be beneficial. METHODS The spatial and temporal information of an electromagnetic catheter tip position sensing system (Magellan, Biosense Inc.) was superimposed on a three-dimensional (3D) CT of the chest in swine using fiducial markers for image registration. Position and orientation of a 6 French catheter with an electromagnetic sensor was displayed in real-time on a corresponding 3D-CT. Catheter navigation within the heart and the great vessels was guided by detailed knowledge about catheter location in relation to cardiac anatomy. RESULTS Anatomic structures including the atrial septum, pulmonary veins, and valvular apparatus were easily identified and used to direct catheter navigation. During the right heart examination, the catheter was navigated through the superior and inferior vena cava to predetermined anatomic locations in right atrium, right ventricle and pulmonary artery. The ablation catheter was also navigated successfully from the aorta through the aortic valve in the left ventricle. No complication was encountered during the experiments. The accuracy and precision of this novel approach to mapping was 4.69 +/- 1.70 mm and 2.22 +/- 0.69 mm, respectively. CONCLUSIONS Real-time display of catheter position and orientation on 3D-CT scans allows accurate and precise catheter navigation in the heart. The detailed anatomic information may improve anatomically based procedures like pulmonary vein ablation and has the potential to decrease radiation times.
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Affiliation(s)
- Stephen B Solomon
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
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Rosahl SK, Gharabaghi A, Liebig T, Feste CD, Tatagiba M, Samii M. Skin markers for surgical planning for intradural lesions of the thoracic spine. Technical note. SURGICAL NEUROLOGY 2002; 58:346-8. [PMID: 12504308 DOI: 10.1016/s0090-3019(02)00863-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preparation for surgery for thoracic intraspinal lesions commonly involves rather difficult X-ray procedures in the operating room. The object of this report is to inform neurosurgeons about a modified technique for preoperative surface localization of intraspinal thoracic pathology. METHODS Adhesive, disposable radiographic skin markers placed at the presumed level of an intraspinal lesion are visualized along with the lesion on sagittal magnetic resonance scans of the thoracic spine. RESULTS The lesion and the skin markers were clearly identified within the same field of view. The lesion itself rather than the vertebral body becomes the reference point for localization. CONCLUSION Preoperative imaging with adhesive skin markers facilitates positioning and draping for surgery for thoracic intraspinal lesions. It may even replace intra-operative X-ray procedures in selected cases.
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Trantakis C, Meixensberger J, Lindner D, Strauss G, Grunst G, Schmidtgen A, Arnold S. Iterative neuronavigation using 3D ultrasound. A feasibility study. Neurol Res 2002; 24:666-70. [PMID: 12392203 DOI: 10.1179/016164102101200735] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Intra-operative ultrasound (iUS) can generate 2D images in real-time as well as near real-time 3D datasets of the current situation during an intervention. Tracked ultrasound can locate the images in 3D space and relate them to patient, devices, andpre-operative planning data. Therefore, tracked US is an efficient means for controlling the validity of pre-operative planning, recognition of changes (brain shift) during the intervention, replanning of the operational path due to situational changes (iterative navigation), and finally, controlling the results (residual tumor). This paper describes a neuronavigation system exploiting this potential of interventional tracked US for permanent control of intervention progress and iterative adaptation of the planned procedure to the current situation.
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Marinho AMN, Barua M, Haller J, Ryken TC. Enhanced anatomic visualization with ultrasound-assisted intracranial image-guidance in neurosurgery. Technol Cancer Res Treat 2002; 1:181-6. [PMID: 12622511 DOI: 10.1177/153303460200100303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anatomical comparisons between ultrasound images and magnetic resonance imaging (MRI)/computed tomography (CT) preoperative images were performed in four ultrasound-assisted image-guided intracranial surgeries. An ultrasound scanner connected to a surgical navigation system allowed the neurosurgeon to acquire useful views from that integration, offering an improved method for visualization. This surgical navigation device and associated ultrasound provides real-time brain shift correction. The accuracy of navigation depends on the identification of the anatomic structures. Despite some limitations of the ultrasound images, the ability to compare preoperative MRI and intraoperative ultrasound proved useful to the surgeon.
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Affiliation(s)
- Alexandre M N Marinho
- Department of Neurosurgery, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242, USA
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Abstract
Medical imaging has been used primarily for diagnosis. In the past 15 years there has been an emergence of the use of images for the guidance of therapy. This process requires three-dimensional localization devices, the ability to register medical images to physical space, and the ability to display position and trajectory on those images. This paper examines the development and state of the art in those processes.
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Affiliation(s)
- R L Galloway
- Department of Biomedical Engineering, Center for Technology Guided Therapy, Vanderbilt University, Nashville, Tennessee 37235, USA.
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