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Bopp MHA, Grote A, Gjorgjevski M, Pojskic M, Saß B, Nimsky C. Enabling Navigation and Augmented Reality in the Sitting Position in Posterior Fossa Surgery Using Intraoperative Ultrasound. Cancers (Basel) 2024; 16:1985. [PMID: 38893106 PMCID: PMC11171013 DOI: 10.3390/cancers16111985] [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: 04/03/2024] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Despite its broad use in cranial and spinal surgery, navigation support and microscope-based augmented reality (AR) have not yet found their way into posterior fossa surgery in the sitting position. While this position offers surgical benefits, navigation accuracy and thereof the use of navigation itself seems limited. Intraoperative ultrasound (iUS) can be applied at any time during surgery, delivering real-time images that can be used for accuracy verification and navigation updates. Within this study, its applicability in the sitting position was assessed. Data from 15 patients with lesions within the posterior fossa who underwent magnetic resonance imaging (MRI)-based navigation-supported surgery in the sitting position were retrospectively analyzed using the standard reference array and new rigid image-based MRI-iUS co-registration. The navigation accuracy was evaluated based on the spatial overlap of the outlined lesions and the distance between the corresponding landmarks in both data sets, respectively. Image-based co-registration significantly improved (p < 0.001) the spatial overlap of the outlined lesion (0.42 ± 0.30 vs. 0.65 ± 0.23) and significantly reduced (p < 0.001) the distance between the corresponding landmarks (8.69 ± 6.23 mm vs. 3.19 ± 2.73 mm), allowing for the sufficient use of navigation and AR support. Navigated iUS can therefore serve as an easy-to-use tool to enable navigation support for posterior fossa surgery in the sitting position.
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Affiliation(s)
- Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
| | - Alexander Grote
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
| | - Marko Gjorgjevski
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
| | - Mirza Pojskic
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
| | - Benjamin Saß
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (A.G.); (M.G.); (M.P.); (B.S.); (C.N.)
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
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Qi Z, Bopp MHA, Nimsky C, Chen X, Xu X, Wang Q, Gan Z, Zhang S, Wang J, Jin H, Zhang J. A Novel Registration Method for a Mixed Reality Navigation System Based on a Laser Crosshair Simulator: A Technical Note. Bioengineering (Basel) 2023; 10:1290. [PMID: 38002414 PMCID: PMC10669875 DOI: 10.3390/bioengineering10111290] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Mixed Reality Navigation (MRN) is pivotal in augmented reality-assisted intelligent neurosurgical interventions. However, existing MRN registration methods face challenges in concurrently achieving low user dependency, high accuracy, and clinical applicability. This study proposes and evaluates a novel registration method based on a laser crosshair simulator, evaluating its feasibility and accuracy. A novel registration method employing a laser crosshair simulator was introduced, designed to replicate the scanner frame's position on the patient. The system autonomously calculates the transformation, mapping coordinates from the tracking space to the reference image space. A mathematical model and workflow for registration were designed, and a Universal Windows Platform (UWP) application was developed on HoloLens-2. Finally, a head phantom was used to measure the system's target registration error (TRE). The proposed method was successfully implemented, obviating the need for user interactions with virtual objects during the registration process. Regarding accuracy, the average deviation was 3.7 ± 1.7 mm. This method shows encouraging results in efficiency and intuitiveness and marks a valuable advancement in low-cost, easy-to-use MRN systems. The potential for enhancing accuracy and adaptability in intervention procedures positions this approach as promising for improving surgical outcomes.
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Affiliation(s)
- Ziyu Qi
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany;
| | - Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany;
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany;
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
| | - Xiaolei Chen
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
| | - Xinghua Xu
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
| | - Qun Wang
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
| | - Zhichao Gan
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
- Medical School of Chinese PLA, Beijing 100853, China
| | - Shiyu Zhang
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
- Medical School of Chinese PLA, Beijing 100853, China
| | - Jingyue Wang
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
- Medical School of Chinese PLA, Beijing 100853, China
| | - Haitao Jin
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
- Medical School of Chinese PLA, Beijing 100853, China
- NCO School, Army Medical University, Shijiazhuang 050081, China
| | - Jiashu Zhang
- Department of Neurosurgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China; (X.C.); (X.X.); (Q.W.); (Z.G.); (S.Z.); (J.W.); (H.J.)
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Bopp MHA, Corr F, Saß B, Pojskic M, Kemmling A, Nimsky C. Augmented Reality to Compensate for Navigation Inaccuracies. SENSORS (BASEL, SWITZERLAND) 2022; 22:9591. [PMID: 36559961 PMCID: PMC9787763 DOI: 10.3390/s22249591] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
This study aims to report on the capability of microscope-based augmented reality (AR) to evaluate registration and navigation accuracy with extracranial and intracranial landmarks and to elaborate on its opportunities and obstacles in compensation for navigation inaccuracies. In a consecutive single surgeon series of 293 patients, automatic intraoperative computed tomography-based registration was performed delivering a high initial registration accuracy with a mean target registration error of 0.84 ± 0.36 mm. Navigation accuracy is evaluated by overlaying a maximum intensity projection or pre-segmented object outlines within the recent focal plane onto the in situ patient anatomy and compensated for by translational and/or rotational in-plane transformations. Using bony landmarks (85 cases), there was two cases where a mismatch was seen. Cortical vascular structures (242 cases) showed a mismatch in 43 cases and cortex representations (40 cases) revealed two inaccurate cases. In all cases, with detected misalignment, a successful spatial compensation was performed (mean correction: bone (6.27 ± 7.31 mm), vascular (3.00 ± 1.93 mm, 0.38° ± 1.06°), and cortex (5.31 ± 1.57 mm, 1.75° ± 2.47°)) increasing navigation accuracy. AR support allows for intermediate and straightforward monitoring of accuracy, enables compensation of spatial misalignments, and thereby provides additional safety by increasing overall accuracy.
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Affiliation(s)
- Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
| | - Felix Corr
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
- EDU Institute of Higher Education, Villa Bighi, Chaplain’s House, KKR 1320 Kalkara, Malta
| | - Benjamin Saß
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Mirza Pojskic
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - André Kemmling
- Department of Neuroradiology, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
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Švaco M, Stiperski I, Dlaka D, Šuligoj F, Jerbić B, Chudy D, Raguž M. Stereotactic Neuro-Navigation Phantom Designs: A Systematic Review. Front Neurorobot 2020; 14:549603. [PMID: 33192433 PMCID: PMC7644893 DOI: 10.3389/fnbot.2020.549603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/16/2020] [Indexed: 11/28/2022] Open
Abstract
Diverse stereotactic neuro-navigation systems are used daily in neurosurgery and novel systems are continuously being developed. Prior to clinical implementation of new surgical tools, methods or instruments, in vitro experiments on phantoms should be conducted. A stereotactic neuro-navigation phantom denotes a rigid or deformable structure resembling the cranium with the intracranial area. The use of phantoms is essential for the testing of complete procedures and their workflows, as well as for the final validation of the application accuracy. The aim of this study is to provide a systematic review of stereotactic neuro-navigation phantom designs, to identify their most relevant features, and to identify methodologies for measuring the target point error, the entry point error, and the angular error (α). The literature on phantom designs used for evaluating the accuracy of stereotactic neuro-navigation systems, i.e., robotic navigation systems, stereotactic frames, frameless navigation systems, and aiming devices, was searched. Eligible articles among the articles written in English in the period 2000-2020 were identified through the electronic databases PubMed, IEEE, Web of Science, and Scopus. The majority of phantom designs presented in those articles provide a suitable methodology for measuring the target point error, while there is a lack of objective measurements of the entry point error and angular error. We identified the need for a universal phantom design, which would be compatible with most common imaging techniques (e.g., computed tomography and magnetic resonance imaging) and suitable for simultaneous measurement of the target point, entry point, and angular errors.
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Affiliation(s)
- Marko Švaco
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Ivan Stiperski
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
| | - Domagoj Dlaka
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Filip Šuligoj
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Bojan Jerbić
- Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
- Department of Surgery, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
- Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
- Department of Anatomy and Clinical Anatomy, School of Medicine University of Zagreb, Zagreb, Croatia
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Dodier P, Winter F, Auzinger T, Mistelbauer G, Frischer JM, Wang WT, Mallouhi A, Marik W, Wolfsberger S, Reissig L, Hammadi F, Matula C, Baumann A, Bavinzski G. Single-stage bone resection and cranioplastic reconstruction: comparison of a novel software-derived PEEK workflow with the standard reconstructive method. Int J Oral Maxillofac Surg 2020; 49:1007-1015. [DOI: 10.1016/j.ijom.2019.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/07/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
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Kaushik A, Dwarakanath T, Bhutani G, Srinivas D. Robot-Based Autonomous Neuroregistration and Neuronavigation: Implementation and Case Studies. World Neurosurg 2020; 134:e256-e271. [DOI: 10.1016/j.wneu.2019.10.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 11/15/2022]
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Batista PD, Machado IP, Roios P, Lavrador J, Cattoni MB, Martins J, Carvalho H. Position and Orientation Errors in a Neuronavigation Procedure: A Stepwise Protocol Using a Cranial Phantom. World Neurosurg 2019; 126:e342-e350. [PMID: 30822590 DOI: 10.1016/j.wneu.2019.02.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 02/16/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Neuronavigation procedures demand high precision and accuracy. Despite this need, there are still few studies analyzing errors in such procedures. The aim of this study was to use a custom-built cranial phantom to measure target position and orientation errors in different phases of a simulated neuronavigation procedure. METHODS A cranial phantom with 10 target sites was designed and imaged with computed tomography and magnetic resonance. A segmentation of a cloud of points of the phantom (ground truth) was obtained using an optical tracking system and compared with the images (imaging phase). Targets and trajectories were then planned with neuronavigation software and compared with the ground truth (planning phase). The same plan was used to identify the points in real space after image-to-phantom registration and calculate the final error of the procedure by comparison with the ground truth (registration and execution phase). RESULTS The mean errors after the imaging phase were 1.11 ± 0.42 mm and 3.23° ± 1.69° for position and orientation, respectively. After planning the mean errors were 1.10 ± 0.39 mm and 5.55° ± 2.91°. The global errors after the registration and mechanical execution were 3.93 ± 1.70 mm and 3.65° ± 1.29°. CONCLUSIONS After a stepwise analysis, registration and mechanical execution were the main contributors to the global position error.
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Affiliation(s)
- Pedro D Batista
- Department of Neurosurgery, Hospital de Santa Maria, CHLN, Lisbon, Portugal.
| | - Inês P Machado
- IDMEC/LAETA, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Roios
- IDMEC/LAETA, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - José Lavrador
- Department of Neurosurgery, Hospital de Santa Maria, CHLN, Lisbon, Portugal; Department of Adult and Paediatric Neurosurgery, King's College Hospital, Foundation Trust, London, United Kingdom
| | - Maria B Cattoni
- Department of Neurosurgery, Hospital de Santa Maria, CHLN, Lisbon, Portugal
| | - Jorge Martins
- IDMEC/LAETA, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Herculano Carvalho
- Department of Neurosurgery, Hospital de Santa Maria, CHLN, Lisbon, Portugal
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Souza VH, Matsuda RH, Peres ASC, Amorim PHJ, Moraes TF, Silva JVL, Baffa O. Development and characterization of the InVesalius Navigator software for navigated transcranial magnetic stimulation. J Neurosci Methods 2018; 309:109-120. [PMID: 30149047 DOI: 10.1016/j.jneumeth.2018.08.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/07/2018] [Accepted: 08/20/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuronavigation provides visual guidance of an instrument during procedures of neurological interventions, and has been shown to be a valuable tool for accurately positioning transcranial magnetic stimulation (TMS) coils relative to an individual's anatomy. Despite the importance of neuronavigation, its high cost, low portability, and low availability of magnetic resonance imaging facilities limit its insertion in research and clinical environments. NEW METHOD We have developed and validated the InVesalius Navigator as the first free, open-source software for image-guided navigated TMS, compatible with multiple tracking devices. A point-based, co-registration algorithm and a guiding interface were designed for tracking any instrument (e.g. TMS coils) relative to an individual's anatomy. RESULTS Localization, precision errors, and repeatability were measured for two tracking devices during navigation in a phantom and in a simulated TMS study. Errors were measured in two commercial navigated TMS systems for comparison. Localization error was about 1.5 mm, and repeatability was about 1 mm for translation and 1° for rotation angles, both within limits established in the literature. COMPARISON WITH EXISTING METHODS Existing TMS neuronavigation software programs are not compatible with multiple tracking devices, and do not provide an easy to implement platform for custom tools. Moreover, commercial alternatives are expensive with limited portability. CONCLUSIONS InVesalius Navigator might contribute to improving spatial accuracy and the reliability of techniques for brain interventions by means of an intuitive graphical interface. Furthermore, the software can be easily integrated into existing neuroimaging tools, and customized for novel applications such as multi-locus and/or controllable-pulse TMS.
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Affiliation(s)
- Victor Hugo Souza
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil.
| | - Renan H Matsuda
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil.
| | - André S C Peres
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil; Instituto Internacional de Neurociência de Natal Edmond e Lily Safra, Instituto Santos Dumont, Rodovia RN 160 Km 03, 3003, 59280-000, Macaíba, RN, Brazil.
| | - Paulo Henrique J Amorim
- Núcleo de Tecnologias Tridimensionais, Centro de Tecnologia da Informação Renato Archer, Rodovia Dom Pedro I Km 143, 13069-901, Campinas, SP, Brazil.
| | - Thiago F Moraes
- Núcleo de Tecnologias Tridimensionais, Centro de Tecnologia da Informação Renato Archer, Rodovia Dom Pedro I Km 143, 13069-901, Campinas, SP, Brazil.
| | - Jorge Vicente L Silva
- Núcleo de Tecnologias Tridimensionais, Centro de Tecnologia da Informação Renato Archer, Rodovia Dom Pedro I Km 143, 13069-901, Campinas, SP, Brazil.
| | - Oswaldo Baffa
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil.
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Shurkhay VA, Goryaynov SA, Kutin MA, Eolchiyan SA, Capitanov DN, Fomichev DV, Kalinin PL, Shkarubo AN, Kopachev DN, Melikyan AG, Nersesyan MV, Shkatova AM, Konovalov AN, Potapov AA. [Application of intraoperative electromagnetic frameless navigation in transcranial and endoscopic neurosurgical interventions]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2017; 81:5-16. [PMID: 29076463 DOI: 10.17116/neiro20178155-16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED The paper summarizes the experience in using a system of electromagnetic intraoperative frameless navigation in various neurosurgical pathologies of the brain. The electromagnetic navigation technique was used for 102 operations in 98 patients, including 36 transnasal endoscopic interventions. There were no intraoprtative and postoperative complications associated with the use of the system. In the process of using the system, factors influencing the accuracy of navigation and requiring additional control by the surgeon were identified. PURPOSE The study purpose was to evaluate the use of electromagnetic navigation in surgical treatment of patients with various brain lesions. MATERIAL AND METHODS The system of electromagnetic navigation was used for 102 operations in 98 patients (42 males and 56 females, including 18 children; median age, 34.8 years (min, 2.2 years; max, 69 years)) in the period from December 2012 to December 2016. In 36 patients, the system was used for endoscopic interventions. In 19 patients, electromagnetic navigation was used in combination with neurophysiological monitoring. RESULTS In our series of cases, the frameless electromagnetic navigation system was used in 66 transcranial operations. The mean error of navigation was 1.9±0.5 mm. In 5 cases, we used the data of preoperative functional MRI (fMRI) and tractography for navigation. At the same time, in all 7 operations with simultaneous direct stimulation of the cortex, there was interference and significant high-frequency noise, which distorted the electrophysiological data. A navigation error of more than 3 mm was associated with the use of neuroimaging data with an increment of more than 3 mm, image artifacts from the head locks, high rate of patient registration, inconsequence of touching points on the patient's head, and unsatisfactory fixation to the skin or subsequent displacement of a non-invasive localizer of the patient. In none of the cases, there was a significant effect of standard metal surgical tools (clamps, tweezers, aspirators) located near the patient's head on the navigation system. In two cases, the use of massive retractors located near the patient's localizer caused noise in the localizer and navigation errors of more than 10 mm due to significant distortions of the electromagnetic field. Thirty-six transnasal endoscopic interventions were performed using the electromagnetic frameless navigation system. The mean navigation error was 2.5±0.8 mm. CONCLUSION In general, electromagnetic navigation is an accurate, safe, and effective technique that can be used in surgical treatment of patients with various brain lesions. The mean navigation error in our series of cases was 1.9±0.5 mm for transcranial surgery and 2.5±0.8 mm for endoscopic surgery. Electromagnetic navigation can be used for different, both transcranial and endoscopic, neurosurgical interventions. Electromagnetic navigation is most convenient for interventions that do not require fixation of the patient's head, in particular for CSF shunting procedures, drainage of various space-occupying lesions (cysts, hematomas, and abscesses), and optimization of the size and selection of options for craniotomy. In repeated interventions, disruption of the normal anatomical relationships and landmarks necessitates application of neuronavigation systems in almost mandatory manner. The use of electromagnetic navigation does not limit application of the entire range of necessary intraoperative neurophysiological examinations at appropriate surgical stages. Succession in application of neuronavigation should be used to get adequate test results.
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Affiliation(s)
- V A Shurkhay
- Burdenko Neurosurgical Institute, Moscow, Russia; Moscow Institute of Physics and Technology, Dolgoprudny Moscow Region, Russia
| | | | - M A Kutin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - D V Fomichev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - P L Kalinin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A N Shkarubo
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - D N Kopachev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A G Melikyan
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A M Shkatova
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
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Ballesteros-Zebadúa P, García-Garduño OA, Galván de la Cruz OO, Arellano-Reynoso A, Lárraga-Gutiérrez JM, Celis MA. Assessment of an image-guided neurosurgery system using a head phantom. Br J Neurosurg 2016; 30:606-610. [DOI: 10.3109/02688697.2016.1173188] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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11
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Widmann G, Schullian P, Ortler M, Bale R. Frameless stereotactic targeting devices: technical features, targeting errors and clinical results. Int J Med Robot 2011; 8:1-16. [DOI: 10.1002/rcs.441] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2011] [Indexed: 01/06/2023]
Affiliation(s)
- Gerlig Widmann
- Medical University of Innsbruck; SIP-Department for Microinvasive Therapy, Department of Radiology; Austria
| | - Peter Schullian
- Medical University of Innsbruck; SIP-Department for Microinvasive Therapy, Department of Radiology; Austria
| | - Martin Ortler
- Medical University of Innsbruck; Department of Neurosurgery; Austria
| | - Reto Bale
- Medical University of Innsbruck; SIP-Department for Microinvasive Therapy, Department of Radiology; Austria
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12
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Paraskevopoulos D, Unterberg A, Metzner R, Dreyhaupt J, Eggers G, Wirtz CR. Comparative study of application accuracy of two frameless neuronavigation systems: experimental error assessment quantifying registration methods and clinically influencing factors. Neurosurg Rev 2011; 34:217-28. [PMID: 21246391 DOI: 10.1007/s10143-010-0302-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 10/12/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
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13
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Thompson EM, Anderson GJ, Roberts CM, Hunt MA, Selden NR. Skull-fixated fiducial markers improve accuracy in staged frameless stereotactic epilepsy surgery in children. J Neurosurg Pediatr 2011; 7:116-9. [PMID: 21194296 DOI: 10.3171/2010.10.peds10352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Surgery to monitor and resect epileptogenic foci may be undertaken in 2 stages, providing an opportunity to use skull-fixated fiducials implanted during the first stage to improve the accuracy of cortical resection during the second stage. This study compared the intrinsic accuracy of skin-based and skull-fixated fiducial markers in registering frameless stereotaxy during pediatric epilepsy surgery. To the authors' knowledge, these modalities of registration have not previously been directly compared in this population. METHODS The authors undertook a retrospective review of pediatric patients who underwent resection of epileptogenic foci in 2 stages with frameless stereotactic assistance, performed by a single surgeon at Oregon Health & Science University. For the first stage (subdural grid implantation), 9 skin fiducial markers were used to register anatomical data in a frameless stereotactic station. Intraoperatively, four 3-mm screws were placed circumferentially around the craniotomy. Postoperatively, thin-slice brain MR and CT images were obtained and fused. For the second stage, the 4 screws were used as fiducial markers to register the stereotactic anatomical data. For both stages, accuracy (difference in millimeters from zero of the manual fiducial registration compared with the computer model) was determined using navigation software. The intrinsic accuracy of these 2 methods of fiducial registration was compared using a paired Student t-test. RESULTS Between 2004 and 2009, 40 pediatric patients with epilepsy underwent frameless stereotactic surgical procedures. Fourteen patients who had 2-stage procedures using skin-based and skull-fixated registration with complete accuracy data were included in this retrospective review. Mean registration error was significantly lower using skull-fixated fiducials (1.35 mm, 95% CI 1.09-1.60 mm) than using skin-based fiducials (1.85 mm, 95% CI 1.56-2.13 mm; p = 0.0016). CONCLUSIONS A significantly higher degree of accuracy was achieved using 4 skull-fixated fiducials compared with using 9 skin-based fiducials. This simple and accurate method for registering frameless stereotactic anatomical data does not involve the potential time, expense, discomfort, and morbidity of extraoperative skull-fixated fiducial placement. The method described in this paper could also be extrapolated to other planned 2-stage cranial surgical procedures such as combined skull base approaches.
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Affiliation(s)
- Eric M Thompson
- Department of Neurological Surgery, Oregon Health & Science University, 3303 SW Bond Avenue, Portland, OR 97239, USA
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Cutini S, Scatturin P, Zorzi M. A new method based on ICBM152 head surface for probe placement in multichannel fNIRS. Neuroimage 2010; 54:919-27. [PMID: 20851195 DOI: 10.1016/j.neuroimage.2010.09.030] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/09/2010] [Accepted: 09/13/2010] [Indexed: 11/30/2022] Open
Abstract
We propose a new probe placement method for multichannel functional Near Infrared Spectroscopy (fNIRS) based on the ICBM152 template, the most commonly used reference brain for neuroimaging. Our method is based on the use of a physical model of the ICBM152 head surface as reference scalp and its validity is supported by previous investigations of cranio-cerebral correlation. The method, intended for fNIRS group studies, dispenses with the use of individual MRI scan and digitizing procedure for each participant. The present approach offers a fast, simple, reproducible and straightforward method to place the probes on the head surface according to the MNI coordinates of the regions of interest with an average measurement error similar to those of previous methods. This ensures that fNIRS results can be readily compared within the neuroimaging community, both across studies and techniques.
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Affiliation(s)
- Simone Cutini
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy.
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15
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Widmann G, Stoffner R, Sieb M, Bale R. Target registration and target positioning errors in computer-assisted neurosurgery: proposal for a standardized reporting of error assessment. Int J Med Robot 2009; 5:355-65. [DOI: 10.1002/rcs.271] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Schramm A, Suarez-Cunqueiro MM, Rücker M, Kokemueller H, Bormann KH, Metzger MC, Gellrich NC. Computer-assisted therapy in orbital and mid-facial reconstructions. Int J Med Robot 2009; 5:111-24. [DOI: 10.1002/rcs.245] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pillai P, Sammet S, Ammirati M. Application accuracy of computed tomography-based, image-guided navigation of temporal bone. Neurosurgery 2008; 63:326-32; discussion 332-3. [PMID: 18981839 DOI: 10.1227/01.neu.0000316429.19314.67] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Although frameless stereotactic techniques have become indispensable in neurosurgery, their technical complexity requires careful definition and evaluation. Navigation is of particular concern when it is applied to approach a complex, tight surgical area like the temporal bone, where every millimeter is important. Theoretically, the temporal bone is an ideal location in which to use image-guided navigation because its bony construct precludes pre- and intraoperative shift. In this context, the feasibility of using a navigational system is determined by the system's accuracy and by the spatial characteristics of the targets. Literature addressing the accuracy of image guidance techniques in temporal bone surgery is relatively sparse. Accuracy of these systems within the temporal bone is still under investigation. We investigated the application accuracy of computed tomography-based, frameless, image-guided navigation to identify various bony structures in the temporal bone via a retrosigmoid approach. METHODS In a total of 10 operations, we performed a retrosigmoid approach simulating operative conditions on either side of 5 whole, fresh cadaveric heads. Six titanium microscrews were implanted around the planned craniotomy site as permanent bone reference markers before the surgical procedure. High-resolution computed tomographic scans were obtained (slice thickness, 0.6-mm, contiguous non-overlapping slices; gantry setting, 0 degrees; scan window diameter, 225 mm; pixel size, >0.44 x 0.44). We used a Stryker navigation system (Stryker Instruments, Kalamazoo, MI) for intraoperative navigation. External and internal targets were selected for calculation of navigation accuracy. RESULTS The system calculated target registration error to be 0.48 +/- 0.21 mm, and the global accuracies (navigation accuracies) were calculated using external over-the-skull and internal targets within the temporal bone. Overall navigation accuracy was 0.91 +/- 0.28 mm; for reaching internal targets within temporal bone, accuracy was 0.94 +/- 0.22 mm; and for external targets, accuracy was 0.83 +/- 0.11 mm. Ninety-five percent of targets could be reached within 1.4 mm of their actual position. CONCLUSION Using high-resolution computed tomography and bone-implanted reference markers, frameless navigation can be as accurate as frame-based stereotaxy in providing a guide to maximize safe surgical approaches to the temporal bone. Although error-free navigation is not possible with the submillimetric accuracy required by direct anatomic contouring of tiny structures within temporal bone, it still provides a road map to maximize safe surgical exposure.
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Affiliation(s)
- Promod Pillai
- Department of Neurological Surgery, The Ohio State University Medical Center, Columbus, Ohio 43210, USA.
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Pfisterer WK, Papadopoulos S, Drumm DA, Smith K, Preul MC. Fiducial Versus Nonfiducial Neuronavigation Registration Assessment and Considerations of Accuracy. Oper Neurosurg (Hagerstown) 2008; 62:201-7; discussion 207-8. [DOI: 10.1227/01.neu.0000317394.14303.99] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Objective:
For frameless stereotaxy, users can choose between anatomic landmarks (ALs) or surface fiducial markers (FMs) for their match points during registration to define an alignment of the head in the physical and radiographic image space. In this study, we sought to determine the concordance among a point-merged FM registration, a point-merged AL registration, and a combined point-merged anatomic/surface-merged (SM) registration, i.e., to determine the accuracy of registration techniques with and without FMs by examining the extent of agreement between the system-generated predicted value and physical measured values.
Methods:
We examined 30 volunteers treated with gamma knife surgery. The frameless stereotactic image-guidance system called the StealthStation (Medtronic Surgical Navigation Technologies, Louisville, CO) was used. Nine FMs were placed on the patient's head and four were placed on a Leksell frame rod-box, which acted as a rigid set to determine the difference in error. For each registration form, we recorded the generated measurement (GM) and the physical measurement (PM) to each of the four checkpoint FMs. Bland and Altman plot difference analyses were used to compare measurement techniques. Correlations and descriptive analyses were completed.
Results:
The mean of values for GMs were 1.14 mm for FM, 2.3 mm for AL, and 0.96 mm for SM registrations. The mean errors of the checkpoints were 3.49 mm for FM, 3.96 mm for AL, and 3.33 mm for SM registrations. The correlation between GMs and PMs indicated a linear relationship for all three methods. AL registration demonstrated the greatest mean difference, followed by FM registration; SM registration had the smallest difference between GMs and PMs. Differences in the anatomic registration methods, including SM registration, compared with FM registration were within a mean ± 1.96 (standard deviation) according to the Bland and Altman analysis.
Conclusion:
For our sample of 30 patients, all three registration methods provided comparable distances to the target tissue for surgical procedures. Users may safely choose anatomic registration as a less costly and more time-efficient registration method for frameless stereotaxy.
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Affiliation(s)
- Wolfgang K. Pfisterer
- Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Stephen Papadopoulos
- Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Denise A. Drumm
- Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kris Smith
- Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark C. Preul
- Neurosurgery Research Laboratory, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Metzger MC, Hohlweg-Majert B, Schön R, Teschner M, Gellrich NC, Schmelzeisen R, Gutwald R. Verification of clinical precision after computer-aided reconstruction in craniomaxillofacial surgery. ACTA ACUST UNITED AC 2007; 104:e1-10. [PMID: 17656126 DOI: 10.1016/j.tripleo.2007.04.015] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Revised: 03/28/2007] [Accepted: 04/17/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Computer-aided surgery (CAS) has proved to be useful in reconstructive craniomaxillofacial surgery. Preoperative creation of virtual models by segmentation of the computerized tomography (CT) dataset and mirroring of the unaffected side allows for precise planning of complex reconstructive procedures. The aim of this study was to evaluate the accuracy of the preoperative planning and the postoperative result regarding the skeletal reconstruction. STUDY DESIGN In a first step, the symmetry of unaffected human skulls and faces were evaluated by 20 midface CT data of skulls and 20 surface-scan data of healthy individuals. By mirroring and adjusting the original and mirrored datasets using a 3-dimensional modeling software, an automatic measurement procedure could evaluate the mean and the maximal modulus of the distances between both datasets. In a second step, 18 consecutive cases were selected which had been treated with CAS support. Group 1 consisted of orbital floor and/or medial wall fractures (n = 12), group 2 consisted of zygomatic bone fractures (n = 4), and group 3 included 2 patients who were treated by secondary orbital reconstruction including reosteotomy of the zygomatic bone (n = 2). To verify the surgical result, the preoperative CT dataset including the virtual planning and the postoperative CT dataset were compared by using image fusion. Additionally, postoperative surface scans and the clinical symptoms of the patients were evaluated. RESULTS No differences between the skull and face symmetry were found. Mean values for distances considering the skull symmetry were 0.83 mm for male and 0.71 mm for female and for the face symmetry 0.65 mm for male and 0.76 mm for female. Comparing the preoperative planning with the postoperative outcome, a mean accuracy of 1.49-4.12 mm with maximum modulus of 2.49-6.00 mm was achieved. Orbital true-to-original reconstructions and the secondary reconstructions were more precise than the reposition of the zygomatic bones. The postoperative acquired surface scans resulted in mean distances from 0.89 to 1.784 mm. Despite these deviations, all patients demonstrated satisfying clinical outcome. CONCLUSION The natural asymmetry in humans influences the accuracy of preoperative planning procedure, when the mirroring tool is used. The accuracy transforming the preoperative planning to the surgical reconstruction using CAS depends on location, surgical approach, and matter of reconstruction.
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Affiliation(s)
- Marc Christian Metzger
- Department of Craniomaxillofacial Surgery, Albert-Ludwigs University Freiburg, Freiburg, Germany.
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Miocinovic S, Zhang J, Xu W, Russo GS, Vitek JL, McIntyre CC. Stereotactic neurosurgical planning, recording, and visualization for deep brain stimulation in non-human primates. J Neurosci Methods 2006; 162:32-41. [PMID: 17275094 PMCID: PMC2075353 DOI: 10.1016/j.jneumeth.2006.12.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Revised: 11/17/2006] [Accepted: 12/13/2006] [Indexed: 11/20/2022]
Abstract
Methodologies for stereotactic neurosurgery and neurophysiological microelectrode recordings (MER) in non-human primate research typically rely on brain atlases that are not customized to the individual animal, and require paper records of MER data. To address these limitations, we developed a software tool (Cicerone) that enables simultaneous interactive 3D visualization of the neuroanatomy, neurophysiology, and neurostimulation data pertinent to deep brain stimulation (DBS) research studies in non-human primates. Cicerone allows for analysis of co-registered magnetic resonance images (MRI), computed tomography (CT) scans, 3D brain atlases, MER data, and DBS electrode(s) with predictions of the volume of tissue activated (VTA) as a function of the stimulation parameters. We used Cicerone to aid the implantation of DBS electrodes in two parkinsonian rhesus macaques, targeting the subthalamic nucleus in one monkey and the globus pallidus in the other. Cicerone correctly predicted the anatomical position of 79% and 73% of neurophysiologically defined MER sites in the two animals, respectively. In contrast, traditional 2D print atlases achieved 61% and 48% accuracy. Our experience suggests that Cicerone can improve anatomical targeting, enhance electrophysiological data visualization, and augment the design of stimulation experiments.
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Affiliation(s)
- Svjetlana Miocinovic
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
| | - Jianyu Zhang
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH
| | - Weidong Xu
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH
| | - Gary S. Russo
- Department of Neurosciences, Cleveland Clinic, Cleveland, OH
| | | | - Cameron C. McIntyre
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH
- * address all correspondence to Cameron C. McIntyre, Ph.D., Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue ND20, Cleveland, OH, 44195, Phone: (216) 445-3264, Fax: (216) 444-9198,
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Willems PWA, van der Sprenkel JWB, Tulleken CAF, Viergever MA, Taphoorn MJB. Neuronavigation and surgery of intracerebral tumours. J Neurol 2006; 253:1123-36. [PMID: 16988793 DOI: 10.1007/s00415-006-0158-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Accepted: 10/21/2005] [Indexed: 10/24/2022]
Abstract
Approximately four decades after the successful clinical introduction of framebased stereotactic neurosurgery by Spiegel and Wycis, frameless stereotaxy emerged to enable more elaborate image guidance in open neurosurgical procedures. Frameless stereotaxy, or neuronavigation, relies on one of several different localizing techniques to determine the position of an operative instrument relative to the surgical field, without the need for a coordinate frame rigidly fixed to the patients' skull. Currently, most systems are based on the optical triangulation of infrared light sources fixed to the surgical instrument. In its essence, a navigation system is a three-dimensional digitiser that correlates its measurements to a reference data set, i.e. a preoperatively acquired CT or MRI image stack. This correlation is achieved through a patient-to-image registration procedure resulting in a mathematical transformation matrix mapping each position in 'world space' onto 'image space'. Thus, throughout the remainder of the surgical procedure, the position of the surgical instrument can be demonstrated on a computer screen, relative to the CT or MRI images. Though neuronavigation has become a routinely used addition to the neurosurgical armamentarium, its impact on surgical results has not yet been examined sufficiently. Therefore, the surgeon is left to decide on a case-by-case basis whether to perform surgery with or without neuronavigation. Future challenges lie in improvement of the interface between the surgeon and the neuronavigator and in reducing the brainshift error, i.e. inaccuracy introduced by changes in tissue positions after image acquisition.
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Affiliation(s)
- P W A Willems
- Department of Neurosurgery, University Medical Center, Utrecht, CX, The Netherlands.
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Nagelhus Hernes TA, Lindseth F, Selbekk T, Wollf A, Solberg OV, Harg E, Rygh OM, Tangen GA, Rasmussen I, Augdal S, Couweleers F, Unsgaard G. Computer-assisted 3D ultrasound-guided neurosurgery: technological contributions, including multimodal registration and advanced display, demonstrating future perspectives. Int J Med Robot 2006; 2:45-59. [PMID: 17520613 DOI: 10.1002/rcs.68] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Navigation systems are now frequently being used for guiding surgical procedures. Existing neuronavigation systems suffer from the lack of updated images when tissue changes during surgery as well as from user-friendly displays of all essential images for accurate and safe surgery guidance. METHODS We have developed various new technologies for improved neuronavigation. Using intraoperative 3D ultrasound (US) imaging, we have developed various registration algorithms for using and updating a complete multimodal and multivolume 3D map for navigation. RESULTS We experienced that advanced multimodal visualization makes it easy to interpret information from several image volumes and modalities simultaneously. Using high quality intraoperative 3D ultrasound, essential preoperative information could be corrected due to brain shift. fMRI and other important preoperative data could then be used together with intraoperative ultrasound imaging for more accurate, safer and improved guidance of therapy. CONCLUSIONS We claim that new features, as demonstrated in the present paper, using intraoperative 3D ultrasound in combination with advanced registration and display algorithms will represent important contributions towards more accurate, safer and more optimized future patient treatment.
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Duyck J, Vrielinck L, Lambrichts I, Abe Y, Schepers S, Politis C, Naert I. Biologic Response of Immediately versus Delayed Loaded Implants Supporting Ill-Fitting Prostheses: An Animal Study. Clin Implant Dent Relat Res 2005; 7:150-8. [PMID: 16219245 DOI: 10.1111/j.1708-8208.2005.tb00059.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Computer-assisted preoperative implant planning and transfer toward the patient allow the production of a prosthesis prior to surgery. This implies that the prosthesis can be installed immediately following implant insertion. An inherent disadvantage of this is a cumulated error, which can lead to prosthesis misfit owing to topographic deviations of the planned versus the installed implants. PURPOSE The aim of this study was to determine whether prosthesis misfit is compromising the osseointegration of immediately versus delayed loaded implants and whether freshly installed implants adapt to the prosthesis. MATERIALS AND METHODS In each of five New Zealand White rabbits, two experimental conditions were compared. One tibia harbored the so-called test implant, which originally showed a vertical misfit of about 500 microm with the prosthesis to which it was tightened immediately after implant installation. The control implant was installed in the other tibia and was allowed to heal during 9 weeks before the prosthesis with the vertical misfit of about 500 microm was connected to it. The prostheses were left in place for 12 weeks, after which the animals were sacrificed. RESULTS All implants healed uneventfully. There were no statistically significant differences between the biologic responses of test and control implants. With a three-dimensional laser scanner, significantly more displacement of the test implants toward the prostheses was observed compared with the control implants. This led to a significant decrease in prosthesis misfit for the test implants compared with the control implants. CONCLUSIONS This study indicates that prosthesis misfit does not per se lead to biologic failure of immediately loaded or of already osseointegrated implants. In addition, immediately loaded implants seem to topographically adapt to the prosthesis, thereby minimizing the existing misfit.
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Affiliation(s)
- Joke Duyck
- Department of Prosthetic Dentistry, BIOMAT Research Group, Katholieke Universiteit Leuven, Leuven, Belgium.
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Smolíková-Wachowiak R, Wachowiak MP, Fenster A, Drangova M. Registration of two-dimensional cardiac images to preprocedural three-dimensional images for interventional applications. J Magn Reson Imaging 2005; 22:219-28. [PMID: 16028254 DOI: 10.1002/jmri.20364] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To evaluate the accuracy and efficiency of rigid-body registration of two-dimensional fast cine and real-time cardiac images to high-resolution and SNR three-dimensional preprocedural reference volumes for application during MRI-guided interventional procedures. MATERIALS AND METHODS Mutual information (MI) and correlation ratio (CR) similarity measures were evaluated. The dependence of registration accuracy and efficiency on different resolution and SNR parameters, and also on cardiac-phase differences was evaluated in a porcine model. Two-dimensional images were initially misoriented at distances (d) of 2-10 mm, and rotations of +/-5 degrees about all axes. Registration error and computation time were evaluated, and performance was also assessed visually. RESULTS The maximum registration error using MI (<2.7 mm and <3.6 degrees ) occurred for d = 10 mm, misrotation of +/-5 degrees , and relative SNR = 1. The computation time was 15 seconds for MI and 10 seconds for CR. CONCLUSION Registration accuracy was not highly dependent on the relative timing, within the cycle, between the two-dimensional and three-dimensional images. Registration using CR was faster than that using MI, although accuracy was marginally higher with MI. J.
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