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Choi SW, Komaiha M, Choi D, Lu N, Gerhardson TI, Fox A, Chaudhary N, Camelo-Piragua S, Hall TL, Pandey AS, Xu Z, Sukovich JR. Neuronavigation-Guided Transcranial Histotripsy (NaviTH) System. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1155-1166. [PMID: 38789304 DOI: 10.1016/j.ultrasmedbio.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE The goal of the work described here was to develop the first neuronavigation-guided transcranial histotripsy (NaviTH) system and associated workflow for transcranial ablation. METHODS The NaviTH system consists of a 360-element, 700 kHz transmitter-receiver-capable transcranial histotripsy array, a clinical neuronavigation system and associated equipment for patient-to-array co-registration and therapy planning and targeting software systems. A workflow for NaviTH treatments, including pre-treatment aberration correction, was developed. Targeting errors stemming from target registration errors (TREs) during the patient-to-array co-registration process, as well as focal shifts caused by skull-induced aberrations, were investigated and characterized. The NaviTH system was used in treatments of two <96 h post-mortem human cadavers and in experiments in two excised human skullcaps. RESULTS The NaviTH was successfully used to create ablations in the cadaver brains as confirmed in post-treatment magnetic resonance imaging A total of three ablations were created in the cadaver brains, and targeting errors of 9, 3.4 and 4.4 mm were observed in corpus callosum, septum and thalamus targets, respectively. Errors were found to be caused primarily by TREs resulting from transducer tracking instrument design flaws and imperfections in the treatment workflow. Transducer tracking instrument design and workflow improvements reduced TREs to <2 mm, and skull-induced focal shifts, following pre-treatment aberration correction, were 0.3 mm. Total targeting errors of the NaviTH system following the noted improvements were 2.5 mm. CONCLUSIONS The feasibility of using the first NaviTH system in a human cadaver model has been determined. Although accuracy still needs to be improved, the proposed system has the potential to allow for transcranial histotripsy therapies without requiring active magnetic resonance treatment guidance.
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Affiliation(s)
- Sang Won Choi
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Mahmoud Komaiha
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Dave Choi
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Ning Lu
- Department of Biomedical Engineering, Stanford University, Stanford, CA, USA
| | - Tyler I Gerhardson
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Adam Fox
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Neeraj Chaudhary
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Zhen Xu
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan R Sukovich
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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Abstract
Mixed reality (MR) merges virtual information into the real world through computer technology, in which the real environment and virtual objects can get spliced in the same image or space at real time so that it can effectively express and integrate the virtual and real worlds and allow high feedback interaction. This technology combines the many advantages of virtual realityand augmented reality, and has a promising future in the medical field. At present, MR technology is just at the beginning stage in the medical field in the world, whose application in neurosurgery is also rarely reported. Given this, the authors described the research progress of MR in neurosurgery including preoperative planning and intraoperative guidance, doctor-patient communication, teaching rounds, physician training, and so on.
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