1
|
Mazzucchi E, Hiepe P, Langhof M, La Rocca G, Pignotti F, Rinaldi P, Sabatino G. Automatic rigid image Fusion of preoperative MR and intraoperative US acquired after craniotomy. Cancer Imaging 2023; 23:37. [PMID: 37055790 PMCID: PMC10099637 DOI: 10.1186/s40644-023-00554-x] [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: 09/15/2022] [Accepted: 04/05/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND Neuronavigation of preoperative MRI is limited by several errors. Intraoperative ultrasound (iUS) with navigated probes that provide automatic superposition of pre-operative MRI and iUS and three-dimensional iUS reconstruction may overcome some of these limitations. Aim of the present study is to verify the accuracy of an automatic MRI - iUS fusion algorithm to improve MR-based neuronavigation accuracy. METHODS An algorithm using Linear Correlation of Linear Combination (LC2)-based similarity metric has been retrospectively evaluated for twelve datasets acquired in patients with brain tumor. A series of landmarks were defined both in MRI and iUS scans. The Target Registration Error (TRE) was determined for each pair of landmarks before and after the automatic Rigid Image Fusion (RIF). The algorithm has been tested on two conditions of the initial image alignment: registration-based fusion (RBF), as given by the navigated ultrasound probe, and different simulated course alignments during convergence test. RESULTS Except for one case RIF was successfully applied in all patients considering the RBF as initial alignment. Here, mean TRE after RBF was significantly reduced from 4.03 (± 1.40) mm to (2.08 ± 0.96 mm) (p = 0.002), after RIF. For convergence test, the mean TRE value after initial perturbations was 8.82 (± 0.23) mm which has been reduced to a mean TRE of 2.64 (± 1.20) mm after RIF (p < 0.001). CONCLUSIONS The integration of an automatic image fusion method for co-registration of pre-operative MRI and iUS data may improve the accuracy in MR-based neuronavigation.
Collapse
Affiliation(s)
- Edoardo Mazzucchi
- Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy.
| | | | | | - Giuseppe La Rocca
- Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Fabrizio Pignotti
- Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | | | - Giovanni Sabatino
- Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
- Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| |
Collapse
|
2
|
Riva M, Arcidiacono UA, Gambaretti M, Gay LG, Sciortino T, Rossi M, Conti Nibali M, Bello L. Intraoperative AIRO mobile computer tomography in frameless stereotactic procedures. Br J Neurosurg 2022; 36:527-531. [PMID: 35379051 DOI: 10.1080/02688697.2022.2057430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Multiple factors can affect the accuracy of neuronavigation, that is a relevant issue, particularly for frameless stereotactic procedures, where precision and optimal image-guidance is crucial for the surgical performance, workflow, and outcome. OBJECTIVE To investigate the impact of AIRO Mobile Computer Tomography in frameless stereotactic approaches. METHODS A retrospective study on 12 patients was performed. All the procedures were deployed using a frameless stereotactic technique, both for the collection of biopsy pathological specimens for diagnosis and insertion of drainage in the treatment of intracranial cystic lesions. RESULTS Twelve patients (eight males, four females) underwent the frameless stereotactic procedure. Mean age at surgery was 55 (±5 SE). The mean volume of the lesion was 23.85 cm3 (±3.13). Six diagnostic biopsies and six cyst drainages were performed. The mean trajectory length was 75.9 ± 11.8 mm. Three posterior fossa lesions (27%) were approached through a retro-sigmoidal burr-hole. A craniotomy for draining a haematoma was performed after detection with AIRO-CT. No permanent neurological dysfunction, in-hospital or 30-day mortality were recorded. CONCLUSION The AIRO-CT resulted feasible with a potential utility for stereotactic procedures. We showed how it could grant the efficacy of the stereotactic procedures reducing some technical and physical sources of inaccuracy, also enhancing safety and allowing prompt detection and management of intraoperative complications.
Collapse
Affiliation(s)
- Marco Riva
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Umberto A Arcidiacono
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Matteo Gambaretti
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo G Gay
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Tommaso Sciortino
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Marco Rossi
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Marco Conti Nibali
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Bello
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
3
|
Riva M, Hiepe P, Frommert M, Divenuto I, Gay LG, Sciortino T, Nibali MC, Rossi M, Pessina F, Bello L. Intraoperative Computed Tomography and Finite Element Modelling for Multimodal Image Fusion in Brain Surgery. Oper Neurosurg (Hagerstown) 2021; 18:531-541. [PMID: 31342073 DOI: 10.1093/ons/opz196] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/16/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND intraoperative computer tomography (iCT) and advanced image fusion algorithms could improve the management of brainshift and the navigation accuracy. OBJECTIVE To evaluate the performance of an iCT-based fusion algorithm using clinical data. METHODS Ten patients with brain tumors were enrolled; preoperative MRI was acquired. The iCT was applied at the end of microsurgical resection. Elastic image fusion of the preoperative MRI to iCT data was performed by deformable fusion employing a biomechanical simulation based on a finite element model. Fusion accuracy was evaluated: the target registration error (TRE, mm) was measured for rigid and elastic fusion (Rf and Ef) and anatomical landmark pairs were divided into test and control structures according to distinct involvement by the brainshift. Intraoperative points describing the stereotactic position of the brain were also acquired and a qualitative evaluation of the adaptive morphing of the preoperative MRI was performed by 5 observers. RESULTS The mean TRE for control and test structures with Rf was 1.81 ± 1.52 and 5.53 ± 2.46 mm, respectively. No significant change was observed applying Ef to control structures; the test structures showed reduced TRE values of 3.34 ± 2.10 mm after Ef (P < .001). A 32% average gain (range 9%-54%) in accuracy of image registration was recorded. The morphed MRI showed robust matching with iCT scans and intraoperative stereotactic points. CONCLUSIONS The evaluated method increased the registration accuracy of preoperative MRI and iCT data. The iCT-based non-linear morphing of the preoperative MRI can potentially enhance the consistency of neuronavigation intraoperatively.
Collapse
Affiliation(s)
- Marco Riva
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy.,Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | | | | | - Ignazio Divenuto
- Unit of Neuroradiology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Lorenzo G Gay
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Tommaso Sciortino
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Marco Conti Nibali
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Marco Rossi
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Federico Pessina
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Lorenzo Bello
- Unit of Oncological Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Oncology and Hemato-oncology, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
4
|
Riva M, Hennersperger C, Milletari F, Katouzian A, Pessina F, Gutierrez-Becker B, Castellano A, Navab N, Bello L. 3D intra-operative ultrasound and MR image guidance: pursuing an ultrasound-based management of brainshift to enhance neuronavigation. Int J Comput Assist Radiol Surg 2017; 12:1711-1725. [DOI: 10.1007/s11548-017-1578-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/20/2017] [Indexed: 12/01/2022]
|
5
|
Haranhalli N, Zeberg H, Lasala P, Altschul D. Radiolucent Skull Clamps for Intra-Operative Imaging: A Technical Note. Cureus 2017; 9:e1020. [PMID: 28348939 PMCID: PMC5346026 DOI: 10.7759/cureus.1020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 02/10/2017] [Indexed: 12/04/2022] Open
Abstract
Conventionally, surgery and procedural-based radiology are performed on different premises. With advances in imaging technology, the operating room is rapidly being transformed into an intraoperative imaging suite. Diagnostic imaging in conjunction with surgery has great utility and by all accounts has great future potential. During the last decade, cone beam computed tomography (CT) scanners have been introduced and have made intraoperative imaging more feasible because these scanners can be made less bulky. The current usefulness of intraoperative magnetic resonance imaging (MRI) or CT for neurosurgery, however, is impaired by the lack of completely radiolucent skull clamps, causing image artifacts. Metal artifacts are particularly problematic, given that they lead to a considerably higher image quality degradation factor for cone beam CT scanners than for conventional CT scanners. Here, we describe our experience with near-radiolucent skull clamps and their associated problems and discuss future improvements to facilitate high-quality image guidance in the field of neurosurgery.
Collapse
Affiliation(s)
- Neil Haranhalli
- Department of Neurological Surgery, Montefiore Medical Center
| | | | - Patrick Lasala
- Department of Neurological Surgery, Montefiore Medical Center
| | - David Altschul
- Department of Neurological Surgery, Montefiore Medical Center
| |
Collapse
|
6
|
Hand-tool-tissue interaction forces in neurosurgery for haptic rendering. Med Biol Eng Comput 2015; 54:1229-41. [PMID: 26718558 DOI: 10.1007/s11517-015-1439-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
Abstract
Haptics provides sensory stimuli that represent the interaction with a virtual or tele-manipulated object, and it is considered a valuable navigation and manipulation tool during tele-operated surgical procedures. Haptic feedback can be provided to the user via cutaneous information and kinesthetic feedback. Sensory subtraction removes the kinesthetic component of the haptic feedback, having only the cutaneous component provided to the user. Such a technique guarantees a stable haptic feedback loop, while it keeps the transparency of the tele-operation system high, which means that the system faithfully replicates and render back the user's directives. This work focuses on checking whether the interaction forces during a bench model neurosurgery operation can lie in the solely cutaneous perception of the human finger pads. If this assumption is found true, it would be possible to exploit sensory subtraction techniques for providing surgeons with feedback from neurosurgery. We measured the forces exerted to surgical tools by three neurosurgeons performing typical actions on a brain phantom, using contact force sensors, while the forces exerted by the tools to the phantom tissue were recorded using a load cell placed under the brain phantom box. The measured surgeon-tool contact forces were 0.01-3.49 N for the thumb and 0.01-6.6 N for index and middle finger, whereas the measured tool-tissue interaction forces were from six to 11 times smaller than the contact forces, i.e., 0.01-0.59 N. The measurements for the contact forces fit the range of the cutaneous sensitivity for the human finger pad; thus, we can say that, in a tele-operated robotic neurosurgery scenario, it would possible to render forces at the fingertip level by conveying haptic cues solely through the cutaneous channel of the surgeon's finger pads. This approach would allow high transparency and high stability of the haptic feedback loop in a tele-operation system.
Collapse
|
7
|
Castelli V, Diversi C, Niccolini M, Mazzolai B, Mussa F, Sinibaldi E. Towards accurate robot-assisted neuroendoscopy using an ergonomic handling interface and a lightweight robot. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:6876-9. [PMID: 25571576 DOI: 10.1109/embc.2014.6945208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We considered a robot-assisted neuroendoscopy, and we developed a handling interface for linking a clinically-used endoscope to a lightweight robot (tool holder) with 7 DoFs. Such a robot holds potential for soft interaction with the surgeon, yet its intrinsic compliance must be suitably tamed not to lose tool targeting accuracy. Starting from practical specifications by neurosurgeons, we designed, fabricated and preliminarily assessed a compact and ergonomic handling interface. Such an interface permitted to easily insert/retract the tool (the measured force was 2 N), and to accurately hit a predefined target (the mean targeting error was below 0.5 mm, within the accuracy level of the optical tracker used for tool localization and pose). The feedback by neurosurgeons was very positive, thus encouraging further developments.
Collapse
|
8
|
De Witte E, Mariën P. Non-organic language deficits following awake brain surgery: a case report. Clin Neurol Neurosurg 2014; 130:11-3. [PMID: 25574862 DOI: 10.1016/j.clineuro.2014.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/24/2014] [Accepted: 12/20/2014] [Indexed: 11/25/2022]
Affiliation(s)
- E De Witte
- Center for Clinical and Experimental Neurolinguistics, Center for Linguistics, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, Belgium
| | - P Mariën
- Center for Clinical and Experimental Neurolinguistics, Center for Linguistics, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, Belgium; Department of Neurology and Memory Clinic, ZNA Middelheim, Antwerp, Belgium.
| |
Collapse
|