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Henderson ER, Hebert KA, Werth PM, Streeter SS, Rosenthal EL, Paulsen KD, Pogue BW, Samkoe KS. Fluorescence guidance improves the accuracy of radiological imaging-guided surgical navigation. J Surg Oncol 2023; 127:490-500. [PMID: 36285723 PMCID: PMC10176708 DOI: 10.1002/jso.27128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/08/2022] [Accepted: 09/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Imaging-based navigation technologies require static referencing between the target anatomy and the optical sensors. Imaging-based navigation is therefore well suited to operations involving bony anatomy; however, these technologies have not translated to soft-tissue surgery. We sought to determine if fluorescence imaging complement conventional, radiological imaging-based navigation to guide the dissection of soft-tissue phantom tumors. METHODS Using a human tissue-simulating model, we created tumor phantoms with physiologically accurate optical density and contrast concentrations. Phantoms were dissected using all possible combinations of computed tomography (CT), magnetic resonance, and fluorescence imaging; controls were included. The data were margin accuracy, margin status, tumor spatial alignment, and dissection duration. RESULTS Margin accuracy was higher for combined navigation modalities compared to individual navigation modalities, and accuracy was highest with combined CT and fluorescence navigation (p = 0.045). Margin status improved with combined CT and fluorescence imaging. CONCLUSIONS At present, imaging-based navigation has limited application in guiding soft-tissue tumor operations due to its inability to compensate for positional changes during surgery. This study indicates that fluorescence guidance enhances the accuracy of imaging-based navigation and may be best viewed as a synergistic technology, rather than a competing one.
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Affiliation(s)
- Eric R. Henderson
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Kendra A. Hebert
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Paul M. Werth
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
- Department of Orthopaedics, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Samuel S. Streeter
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Eben L. Rosenthal
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith D. Paulsen
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
- Dartmouth Cancer Center, Dartmouth Health, Lebanon, New Hampshire, USA
| | - Brian W. Pogue
- Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kimberley S. Samkoe
- Department of Biomedical Engineering, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
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Sambri A, Fiore M, Giannini C, Pipola V, Zucchini R, Aparisi Gomez MP, Musa Aguiar P, Gasbarrini A, De Paolis M. Primary Tumors of the Sacrum: Imaging Findings. Curr Med Imaging 2021; 18:170-186. [PMID: 33982654 DOI: 10.2174/1573405617666210512011923] [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: 11/05/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/22/2022]
Abstract
The diagnosis of sacral neoplasms is often delayed because they tend to remain clinically silent for a long time. Imaging is useful at all stages of managing sacral bone tumors: from the detection of the neoplasm to the long-term follow-up. Radiographs are recommended as the modality of choice to begin the imaging workup of a patient with known or suspected sacral pathology. More sensitive examinations such as computerized tomography (CT), magnetic resonance (MRI), or scintigraphy are often necessary. The morphological features of the lesions on CT and MRI help to orientate the diagnosis. Although some imaging characteristics are helpful to limit the differential diagnosis, an imaging-guided biopsy is often ultimately required to establish a specific diagnosis. Imaging is of paramount importance even in the long-term follow-up in order to assess any residual tumor when surgical resection is incomplete, to assess the efficacy of adjuvant chemotherapy and radiotherapy, and to detect recurrence.
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Affiliation(s)
- Andrea Sambri
- University of Bologna, Bologna, Italy.,IRCCS Azienda Ospedaliero Universitaria Policlinico di Sant’Orsola, Bologna, Italy
| | | | | | | | | | - Maria Pilar Aparisi Gomez
- Department of Radiology, Auckland City Hospital; 2 Park Road, Grafton, 1023 Auckland, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre; Calle Valle de la Ballestera, 59, 46015 Valencia, Spain
| | - Paula Musa Aguiar
- Serdil, Clinica de Radiologia e Diagnóstico por Imagem; R. São Luís, 96 - Santana, Porto Alegre - RS, 90620-170. Brazil
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New Techniques for Diagnosis and Treatment of Musculoskeletal Tumors: Methods of Intraoperative Margin Detection. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ewurum CH, Guo Y, Pagnha S, Feng Z, Luo X. Surgical Navigation in Orthopedics: Workflow and System Review. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1093:47-63. [PMID: 30306471 DOI: 10.1007/978-981-13-1396-7_4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Orthopedic surgery is a widely performed clinical procedure that deals with problems in relation to the bones, joints, and ligaments of the human body, such as musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders. Surgical navigation is generally recognized as the next generation technology of orthopedic surgery. The development of orthopedic navigation systems aims to analyze pre-, intra- and/or postoperative data in multiple modalities and provide an augmented reality 3-D visualization environment to improve clinical outcomes of surgical orthopedic procedures. This chapter investigates surgical navigation techniques and systems that are currently available in orthopedic procedures. In particular, optical tracking, electromagnetic localizers and stereoscopic vision, as well as commercialized orthopedic navigation systems are thoroughly discussed. Moreover, advances and development trends in orthopedic navigation are also discussed in this chapter. While current orthopedic navigation systems enable surgeons to make precise decisions in the operating room by integrating surgical planning, instrument tracking, and intraoperative imaging, it still remains an active research field which provides orthopedists with various technical disciplines, e.g., medical imaging, computer science, sensor technology, and robotics, to further develop current orthopedic navigation methods and systems.
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Affiliation(s)
| | - Yingying Guo
- Department of Computer Science, Xiamen University, Xiamen, China
| | - Seang Pagnha
- Department of Computer Science, Xiamen University, Xiamen, China
| | - Zhao Feng
- Department of Computer Science, Xiamen University, Xiamen, China
| | - Xiongbiao Luo
- Department of Computer Science, Xiamen University, Xiamen, China.
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Ritacco LE, Milano FE, Farfalli GL, Ayerza MA, Muscolo DL, Albergo JI, Aponte-Tinao LA. Virtual Planning and Allograft Preparation Guided by Navigation for Reconstructive Oncologic Surgery: A Technical Report. JBJS Essent Surg Tech 2017; 7:e30. [PMID: 30233965 DOI: 10.2106/jbjs.st.17.00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Advanced virtual simulators can be used to accurately detect the best allograft according to size and shape. Indications & Contraindications Step 1 Acquisition of Medical Images Obtain a multislice CT scan and a magnetic resonance imaging (MRI) scan preoperatively for each patient; however, if the time between the scans and the surgery is >1 month, consider repeating the MRI because the size of the tumor may have changed during that time. Step 2 Select an Allograft Using Virtual Imaging to Optimize Size Matching Load DICOM images into a virtual simulation station (Windows 7 Service Pack 1, 64 bit, Intel Core i5/i7 or equivalent) and use mediCAS planning software (medicas3d.com) or equivalent (Materialise Mimics or Amira software [FEI]) for image segmentation and virtual simulation with STL (stereolithography) files. Step 3 Plan and Outline the Tumor Margins on the Preoperative Imaging Determine and outline the tumor margin on manually fused CT and MRI studies using the registration tool of the mediCAS planning software or equivalent (Materialise Mimics software.). Step 4 Plan and Outline the Same Osteotomies on the Allograft Determine and outline the osteotomies between host and donor using the registration tool of the mediCAS planning software or equivalent (Materialise Mimics software.). Step 5 Assess the Patient and Allograft in a Virtual Scenario Be sure to consider the disintegration of bone tissue that occurs during the osteotomy and corresponds to the thickness of the blade (approximately 1.5 mm). Step 6 Navigation Settings A tool of the mediCAS planning software allows the virtual preoperative planning (STL files) to be transferred to the surgical navigation format, DICOM files. Step 7 Patient and Allograft Intraoperative Navigation The tumor and allograft are resected using the navigated guidelines, which were previously planned with the virtual platform. Results The 3D virtual preoperative planning and surgical navigation software are tools designed to increase the accuracy of bone tumor resection and allograft reconstruction3. Pitfalls & Challenges
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Affiliation(s)
- Lucas E Ritacco
- Institute of Orthopedics, "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Federico E Milano
- Institute of Orthopedics, "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Germán L Farfalli
- Institute of Orthopedics, "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Miguel A Ayerza
- Institute of Orthopedics, "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Domingo L Muscolo
- Institute of Orthopedics, "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Jose I Albergo
- Institute of Orthopedics, "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Luis A Aponte-Tinao
- Institute of Orthopedics, "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Drazin D, Bhamb N, Al-Khouja LT, Kappel AD, Kim TT, Johnson JP, Brien E. Image-guided resection of aggressive sacral tumors. Neurosurg Focus 2017; 42:E15. [PMID: 28041320 DOI: 10.3171/2016.6.focus16125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The aim of this study was to identify and discuss operative nuances utilizing image guidance in the surgical management of aggressive sacral tumors. METHODS The authors report on their single-institution, multi-surgeon, retrospective case series involving patients with pathology-proven aggressive sacral tumors treated between 2009 and 2016. They also reviewed the literature to identify articles related to aggressive sacral tumors, their diagnosis, and their surgical treatment and discuss the results together with their own experience. Information, including background, imaging, treatment, and surgical pearls, is organized by tumor type. RESULTS Review of the institutional records identified 6 patients with sacral tumors who underwent surgery between 2009 and 2016. All 6 patients were treated with image-guided surgery using cone-beam CT technology (O-arm). The surgical technique used is described in detail, and 2 illustrative cases are presented. From the literature, the authors compiled information about chordomas, chondrosarcomas, giant cell tumors, and osteosarcomas and organized it by tumor type, providing a detailed discussion of background, imaging, and treatment as well as surgical pearls for each tumor type. CONCLUSIONS Aggressive sacral tumors can be an extremely difficult challenge for both the patient and the treating physician. The selected surgical intervention varies depending on the type of tumor, size, and location. Surgery can have profound risks including neural compression, lumbopelvic instability, and suboptimal oncological resection. Focusing on the operative nuances for each type can help prevent many of these complications. Anecdotal evidence is provided that utilization of image-guided surgery to aid in tumor resection at our institution has helped reduce blood loss and the local recurrence rate while preserving function in both malignant and aggressive benign tumors affecting the sacrum.
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Affiliation(s)
| | - Neil Bhamb
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Ari D Kappel
- Department of Neurosurgery, Stony Brook University Medical Center, Stony Brook, New York; and
| | - Terrence T Kim
- Departments of 1 Neurosurgery and.,Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - J Patrick Johnson
- Departments of 1 Neurosurgery and.,Department of Neurosurgery, University of California, Davis, Sacramento, California
| | - Earl Brien
- Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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