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Dhawan S, Chen CC. Comparison meta-analysis of intraoperative MRI-guided needle biopsy versus conventional stereotactic needle biopsies. Neurooncol Adv 2024; 6:vdad129. [PMID: 38187873 PMCID: PMC10771274 DOI: 10.1093/noajnl/vdad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
Background MRI-guided needle biopsy (INB) is an emerging alternative to conventional frame-based or frameless stereotactic needle biopsy (SNB). Studies of INB have been limited to select case series, and comparative studies between INB and SNB remain a missing gap in the literature. We performed a meta-analysis to compare INB and SNB literature in terms of diagnostic yield, surgical morbidity and mortality, tumor size, and procedural time. Methods We identified 36 separate cohorts in 26 studies of SNB (including both frameless and frame-based biopsies, 3374 patients) and 27 studies of INB (977 patients). Meta-regression and meta-analysis by proportions were performed. Results Relative to publications that studied SNB, publications studying INB more likely involved brain tumors located in the eloquent cerebrum (79.4% versus 62.6%, P = 0.004) or are smaller in maximal diameter (2.7 cm in INB group versus 3.6 cm in the SNB group, P = .032). Despite these differences, the pooled estimate of diagnostic yield for INB was higher than SNB (95.4% versus 92.3%, P = .026). The pooled estimate of surgical morbidity was higher in the SNB group (12.0%) relative to the INB group (6.1%) (P = .004). Mortality after the procedure was comparable between INB and SNB (1.7% versus 2.3%, P = .288). Procedural time was statistically comparable at 90.3 min (INB) and 103.7 min (SNB), respectively (P = .526). Conclusions Our meta-analysis indicates that, relative to SNB, INB is more often performed for the challenging, smaller-sized brain tumors located in the eloquent cerebrum. INB is associated with lower surgical morbidity and improved diagnostic yield.
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Affiliation(s)
- Sanjay Dhawan
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
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2
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Ius T, Sabatino G, Panciani PP, Fontanella MM, Rudà R, Castellano A, Barbagallo GMV, Belotti F, Boccaletti R, Catapano G, Costantino G, Della Puppa A, Di Meco F, Gagliardi F, Garbossa D, Germanò AF, Iacoangeli M, Mortini P, Olivi A, Pessina F, Pignotti F, Pinna G, Raco A, Sala F, Signorelli F, Sarubbo S, Skrap M, Spena G, Somma T, Sturiale C, Angileri FF, Esposito V. Surgical management of Glioma Grade 4: technical update from the neuro-oncology section of the Italian Society of Neurosurgery (SINch®): a systematic review. J Neurooncol 2023; 162:267-293. [PMID: 36961622 PMCID: PMC10167129 DOI: 10.1007/s11060-023-04274-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/20/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE The extent of resection (EOR) is an independent prognostic factor for overall survival (OS) in adult patients with Glioma Grade 4 (GG4). The aim of the neuro-oncology section of the Italian Society of Neurosurgery (SINch®) was to provide a general overview of the current trends and technical tools to reach this goal. METHODS A systematic review was performed. The results were divided and ordered, by an expert team of surgeons, to assess the Class of Evidence (CE) and Strength of Recommendation (SR) of perioperative drugs management, imaging, surgery, intraoperative imaging, estimation of EOR, surgery at tumor progression and surgery in elderly patients. RESULTS A total of 352 studies were identified, including 299 retrospective studies and 53 reviews/meta-analysis. The use of Dexamethasone and the avoidance of prophylaxis with anti-seizure medications reached a CE I and SR A. A preoperative imaging standard protocol was defined with CE II and SR B and usefulness of an early postoperative MRI, with CE II and SR B. The EOR was defined the strongest independent risk factor for both OS and tumor recurrence with CE II and SR B. For intraoperative imaging only the use of 5-ALA reached a CE II and SR B. The estimation of EOR was established to be fundamental in planning postoperative adjuvant treatments with CE II and SR B and the stereotactic image-guided brain biopsy to be the procedure of choice when an extensive surgical resection is not feasible (CE II and SR B). CONCLUSIONS A growing number of evidences evidence support the role of maximal safe resection as primary OS predictor in GG4 patients. The ongoing development of intraoperative techniques for a precise real-time identification of peritumoral functional pathways enables surgeons to maximize EOR minimizing the post-operative morbidity.
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Affiliation(s)
- Tamara Ius
- Division of Neurosurgery, Head-Neck and NeuroScience Department, University Hospital of Udine, Udine, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
- Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Pier Paolo Panciani
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
| | - Marco Maria Fontanella
- Department of Neuro-Oncology, University of Turin and City of Health and Science Hospital, 10094, Torino, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, University of Turin and City of Health and Science Hospital, 10094, Torino, Italy
- Neurology Unit, Hospital of Castelfranco Veneto, 31033, Castelfranco Veneto, Italy
| | - Antonella Castellano
- Department of Neuroradiology, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Giuseppe Maria Vincenzo Barbagallo
- Department of Medical and Surgical Sciences and Advanced Technologies (G.F. Ingrassia), Neurological Surgery, Policlinico "G. Rodolico - San Marco" University Hospital, University of Catania, Catania, Italy
- Interdisciplinary Research Center On Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Francesco Belotti
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Giuseppe Catapano
- Division of Neurosurgery, Department of Neurological Sciences, Ospedale del Mare, Naples, Italy
| | | | - Alessandro Della Puppa
- Neurosurgical Clinical Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Di Meco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Johns Hopkins Medical School, Baltimore, MD, USA
| | - Filippo Gagliardi
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini," Neurosurgery Unit, University of Turin, Torino, Italy
| | | | - Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica Delle Marche, Azienda Ospedali Riuniti, Ancona, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | | | - Federico Pessina
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Italy
- Neurosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Italy
| | - Fabrizio Pignotti
- Institute of Neurosurgery, Fondazione Policlinico Gemelli, Catholic University, Rome, Italy
- Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| | - Giampietro Pinna
- Unit of Neurosurgery, Department of Neurosciences, Hospital Trust of Verona, 37134, Verona, Italy
| | - Antonino Raco
- Division of Neurosurgery, Department of NESMOS, AOU Sant'Andrea, Sapienza University, Rome, Italy
| | - Francesco Sala
- Department of Neurosciences, Biomedicines and Movement Sciences, Institute of Neurosurgery, University of Verona, 37134, Verona, Italy
| | - Francesco Signorelli
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, Neurosurgery Unit, University "Aldo Moro", 70124, Bari, Italy
| | - Silvio Sarubbo
- Department of Neurosurgery, Santa Chiara Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Miran Skrap
- Division of Neurosurgery, Head-Neck and NeuroScience Department, University Hospital of Udine, Udine, Italy
| | | | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | | | | | - Vincenzo Esposito
- Department of Neurosurgery "Giampaolo Cantore"-IRCSS Neuromed, Pozzilli, Italy
- Department of Human, Neurosciences-"Sapienza" University of Rome, Rome, Italy
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A Comparison of the Safety, Efficacy, and Accuracy of Frame-Based versus Remebot Robot-Assisted Stereotactic Systems for Biopsy of Brainstem Tumors. Brain Sci 2023; 13:brainsci13020362. [PMID: 36831906 PMCID: PMC9954386 DOI: 10.3390/brainsci13020362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Brainstem tumors are rare and extremely heterogeneous and present significant challenges in surgical treatment. Thus, biopsies often set the foundation for the diagnosis of brainstem tumors. Multimodal, image-guided, robot-assisted frameless stereotactic biopsies are increasingly popular in neurosurgery centers. This study aimed to compare the safety, efficacy, and duration of the Remebot robot-assisted (Remebot) frameless brainstem tumor biopsy versus those of frame-based stereotactic biopsy. METHOD A retrospective analysis of 33 patients with brainstem tumors who underwent stereotactic brainstem biopsies in the department of neurosurgery from January 2016 to January 2021 was conducted. The patients were divided into two groups: the Remebot group (n = 22) and the frame-based group (n = 11). The clinical characteristics, trajectory strategy, duration of procedure, diagnostic yielding, histopathological diagnosis, and postoperative complications were retrospectively analyzed and compared between the groups. RESULTS More pediatric patients performed Remebot frameless brainstem tumor biopsy than frame-based biopsy, with a mean age of 17.3 ± 18.7 vs. 32.8 ± 17.1 (p = 0.027). The diagnostic yield had no significant difference in the two groups, with the diagnostic yield of frame-based biopsy and Remebot frameless brain biopsy being 90.9% and 95.5%, respectively. The time of the total process was 124.5 min for the frame-based biopsy and 84.7 min for the Remebot frameless brain biopsy (p < 0.001). There were no significant differences with respect to the occurrence of complication or the duration of the operation between the two groups. CONCLUSION Remebot frameless stereotactic brainstem biopsy is as safe and efficacious as frame-based stereotactic biopsy. However, Remebot frameless biopsy can reduce the total duration of the procedure and has better application in young pediatric patients. Remebot frameless stereotactic biopsies can be a better option towards the safe and efficient treatment of brainstem tumors.
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Bex A, Mathon B. Advances, technological innovations, and future prospects in stereotactic brain biopsies. Neurosurg Rev 2022; 46:5. [PMID: 36471144 PMCID: PMC9734929 DOI: 10.1007/s10143-022-01918-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Stereotactic brain biopsy is one of the most frequently performed brain surgeries. This review aimed to expose the latest cutting-edge and updated technologies and innovations available to neurosurgeons to safely perform stereotactic brain biopsy by minimizing the risks of complications and ensuring that the procedure is successful, leading to a histological diagnosis. We also examined methods for improving preoperative, intraoperative, and postoperative workflows. We performed a comprehensive state-of-the-art literature review. Intraoperative histology, fluorescence, and imaging techniques appear as smart tools to improve the diagnostic yield of biopsy. Constant innovations such as optical methods and augmented reality are also being made to increase patient safety. Robotics and integrated imaging techniques provide an enhanced intraoperative workflow. Patients' management algorithms based on early discharge after biopsy optimize the patient's personal experience and make the most efficient possible use of the available hospital resources. Many new trends are emerging, constantly improving patient care and safety, as well as surgical workflow. A parameter that must be considered is the cost-effectiveness of these devices and the possibility of using them on a daily basis. The decision to implement a new instrument in the surgical workflow should also be dependent on the number of procedures per year, the existing stereotactic equipment, and the experience of each center. Research on patients' postbiopsy management is another mandatory approach to enhance the safety profile of stereotactic brain biopsy and patient satisfaction, as well as to reduce healthcare costs.
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Affiliation(s)
- Alix Bex
- Department of Neurosurgery, CHR Citadelle, Liege, Belgium
| | - Bertrand Mathon
- Department of Neurosurgery, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 47-83, Boulevard de L'Hôpital, 75651 Cedex 13, Paris, France.
- ICM, INSERM U 1127, CNRS UMR 7225, UMRS, Paris Brain Institute, Sorbonne University, 1127, Paris, France.
- GRC 23, Brain Machine Interface, APHP, Sorbonne University, Paris, France.
- GRC 33, Robotics and Surgical Innovation, APHP, Sorbonne University, Paris, France.
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Frameless robot-assisted stereotactic biopsy: an effective and minimally invasive technique for pediatric diffuse intrinsic pontine gliomas. J Neurooncol 2022; 160:107-114. [PMID: 35997920 DOI: 10.1007/s11060-022-04122-4] [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: 07/22/2022] [Accepted: 08/19/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Diffuse intrinsic pontine gliomas (DIPGs) are prone to high surgical risks, and they could even lead to death due to their specific sites. To determine the value of frameless robot-assisted stereotactic biopsies of DIPGs, when compared it with microsurgical biopsies. METHODS We conducted a retrospective study of 71 pediatric patients who underwent biopsies from January 2016 to January 2021. (i) group 1: microsurgical biopsies, and (ii) group 2: frameless robot-assisted stereotactic biopsies. Demographic information, neuroimaging characteristics, pathological diagnoses, operation time, postoperative intensive care unit (ICU) stay time, postoperative hospitalization time, complications, cost, and perioperative mortality rate (POMR) were collected for analyses. RESULTS 32 Cases underwent microsurgical biopsies (group 1) and 39 cases underwent frameless robot-assisted stereotactic biopsies (group 2). All cases were accurately diagnosed after surgery. There was no significant difference in gender, age, symptom times and tumor volumes between the two groups (p > 0.05); operation time, postoperative ICU, stay time and postoperative hospitalization time were longer in group 1 than in group 2 (p < 0.001); the intraoperative bleeding volumes and cost were higher in group 1 than in group 2 (p < 0.001). Group 1 patients required more perioperative blood transfusion than group 2 (p = 0.001), and the new neurological impairments were more frequent in group 1 than in group 2 (p = 0.003). The POMR was 9.38% (3/32) in group 1 and 0 in group 2 (p = 0.087). CONCLUSIONS Frameless robot-assisted stereotactic biopsy was an effective and minimally invasive technique for pediatric DIPGs.
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Abstract
This article discusses intraoperative imaging techniques used during high-grade glioma surgery. Gliomas can be difficult to differentiate from surrounding tissue during surgery. Intraoperative imaging helps to alleviate problems encountered during glioma surgery, such as brain shift and residual tumor. There are a variety of modalities available all of which aim to give the surgeon more information, address brain shift, identify residual tumor, and increase the extent of surgical resection. The article starts with a brief introduction followed by a review of with the latest advances in intraoperative ultrasound, intraoperative MRI, and intraoperative computed tomography.
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Affiliation(s)
- Thomas Noh
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Hawaii Pacific Health, John A Burns School of Medicine, Honolulu, Hawaii, USA
| | - Martina Mustroph
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA.
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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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8
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Saß B, Pojskic M, Bopp M, Nimsky C, Carl B. Comparing Fiducial-Based and Intraoperative Computed Tomography-Based Registration for Frameless Stereotactic Brain Biopsy. Stereotact Funct Neurosurg 2020; 99:79-89. [PMID: 32992321 DOI: 10.1159/000510007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this work was to compare fiducial-based and intraoperative computed tomography (iCT)-based registration for frameless stereotactic brain biopsy. METHODS Of 50 frameless stereotactic biopsies with the VarioGuide, 30 cases were registered as iCT based and 20 as fiducial based. Statistical analysis of the target registration error (TRE), dose length product, effective radiation dose (ED), operation time, and diagnostic yield was performed. RESULTS The mean TRE was significantly lower using iCT-based registration (mean ± SD: 0.70 ± 0.32 vs. 2.43 ± 0.73 mm, p < 0.0001). The ED was significantly lower when using iCT-based registration compared to standard navigational CT (mean ± SD: 0.10 ± 0.13 vs. 2.23 ± 0.34 mSv, p < 0.0001). Post-biopsy iCT was associated with a significant lower (p < 0.0001) ED compared to standard CT (mean ± SD: 1.04 ± 0.18 vs. 1.65 ± 0.26 mSv). The mean surgical time was shorter using iCT-based registration, although the mean total operating room (OR) time did not differ significantly. The diagnostic yield was 96.7% (iCT group) versus 95% (fiducial group). Post-biopsy imaging revealed severe bleeding in 3.3% (iCT group) versus 5% (fiducial group). CONCLUSION iCT-based registration for frameless stereotactic biopsies increases the accuracy significantly without negative effects on the surgical time or the overall time in the OR. Appropriate scan protocols in iCT registration contribute to a significant reduction of the radiation exposure. The high accuracy of the iCT makes it the more favorable registration strategy when taking biopsies of small tumors or lesions near eloquent brain areas.
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Affiliation(s)
- Benjamin Saß
- Department of Neurosurgery, University Marburg, Marburg, Germany,
| | - Mirza Pojskic
- Department of Neurosurgery, University Marburg, Marburg, Germany
| | - Miriam Bopp
- Department of Neurosurgery, University Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany
| | - Barbara Carl
- Department of Neurosurgery, University Marburg, Marburg, Germany.,Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
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Wu S, Wang J, Gao P, Liu W, Hu F, Jiang W, Lei T, Shu K. A comparison of the efficacy, safety, and duration of frame-based and Remebot robot-assisted frameless stereotactic biopsy. Br J Neurosurg 2020; 35:319-323. [PMID: 32940070 DOI: 10.1080/02688697.2020.1812519] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy, safety, and duration of Remebot robot-assisted frameless brain biopsy with those of standard frame-based stereotactic biopsy. PATIENTS AND METHODS A retrospective analysis of 66 patients undergoing stereotactic brain biopsy in our department from January 2015 to January 2019 was performed. We divided the patients into two groups: the frame-based group (n = 35) and the Remebot robot group (n = 31). Data on clinical characteristics, total procedure length, overall discomfort, diagnostic yield, complications, and postoperative length of hospital stay were retrospectively reviewed and compared between these two groups. RESULTS No significant difference in diagnostic yield was detected in the two groups, with frame-based biopsy having a diagnostic yield of 91.4% and Remebot robot-assisted frameless brain biopsy having a diagnostic yield of 93.5%. The duration of the total procedure was 116.5 min for the frame-based biopsy and 80.1 min for the Remebot robot-assisted frameless brain biopsy (p < 0.001). There were no statistically significant differences in complication rate or postoperative duration of hospitalization between the two groups. The overall patient discomfort in the frame-based group was significantly greater than that in the Remebot robot group (visual analog scale score 2.7 ± 1.2 versus 1.5 ± 0.7, p = 0.001). CONCLUSIONS Remebot robot-assisted frameless brain biopsy was as efficacious and safe as standard stereotactic frame-based biopsy. However, frameless biopsy can alleviate the suffering of the patient and reduce the total duration of the procedure. Remebot robot-assisted frameless brain biopsy is easy to use and better accepted by patients than frame-based biopsy.
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Affiliation(s)
- Shiqiang Wu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junwen Wang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Pan Gao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weihua Liu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Hu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Jiang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Lei
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Minchev G, Kronreif G, Ptacek W, Kettenbach J, Micko A, Wurzer A, Maschke S, Wolfsberger S. Frameless Stereotactic Brain Biopsies: Comparison of Minimally Invasive Robot-Guided and Manual Arm-Based Technique. Oper Neurosurg (Hagerstown) 2020; 19:292-301. [DOI: 10.1093/ons/opaa123] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/17/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Most brain biopsies are still performed with the aid of a navigation-guided mechanical arm. Due to the manual trajectory alignment without rigid skull contact, frameless aiming devices are prone to considerably lower accuracy.
OBJECTIVE
To compare a novel minimally invasive robot-guided biopsy technique with rigid skull fixation to a standard frameless manual arm biopsy procedure.
METHODS
Accuracy, procedural duration, diagnostic yield, complication rate, and cosmetic result were retrospectively assessed in 40 consecutive cases of frameless stereotactic biopsies and compared between a minimally invasive robotic technique using the iSYS1 guidance device (iSYS Medizintechnik GmbH) (robot-guided group [ROB], n = 20) and a manual arm-based technique (group MAN, n = 20).
RESULTS
Application of the robotic technique resulted in significantly higher accuracy at entry point (group ROB median 1.5 mm [0.4-3.2 mm] vs manual arm-based group (MAN) 2.2 mm [0.2-5.2 mm], P = .019) and at target point (group ROB 1.5 mm [0.4-2.8 mm] vs group MAN 2.8 mm [1.4-4.9 mm], P = .001), without increasing incision to suture time (group ROB 30.0 min [20-45 min vs group MAN 32.5 min [range 20-60 min], P = .09) and significantly shorter skin incision length (group ROB 16.3 mm [12.7-23.4 mm] vs group MAN 24.2 mm [18.0-37.0 mm], P = .008).
CONCLUSION
According to our data, the proposed technique of minimally invasive robot-guided brain biopsies can improve accuracy without increasing operating time while being equally safe and effective compared to a standard frameless arm-based manual biopsy technique.
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Affiliation(s)
- Georgi Minchev
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Gernot Kronreif
- Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
| | - Wolfgang Ptacek
- Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
| | - Joachim Kettenbach
- Institute of Diagnostic, Interventional Radiology and Nuclear Medicine, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Alexander Micko
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Ayguel Wurzer
- Department of Neurosurgery, Medical University of Vienna, Austria
| | - Svenja Maschke
- Department of Neurosurgery, Medical University of Vienna, Austria
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11
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Minchev G, Kronreif G, Ptacek W, Dorfer C, Micko A, Maschke S, Legnani FG, Widhalm G, Knosp E, Wolfsberger S. A novel robot-guided minimally invasive technique for brain tumor biopsies. J Neurosurg 2020; 132:150-158. [PMID: 30660122 DOI: 10.3171/2018.8.jns182096] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/28/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As decisions regarding tumor diagnosis and subsequent treatment are increasingly based on molecular pathology, the frequency of brain biopsies is increasing. Robotic devices overcome limitations of frame-based and frameless techniques in terms of accuracy and usability. The aim of the present study was to present a novel, minimally invasive, robot-guided biopsy technique and compare the results with those of standard burr hole biopsy. METHODS A tubular minimally invasive instrument set was custom-designed for the iSYS-1 robot-guided biopsies. Feasibility, accuracy, duration, and outcome were compared in a consecutive series of 66 cases of robot-guided stereotactic biopsies between the minimally invasive (32 patients) and standard (34 patients) procedures. RESULTS Application of the minimally invasive instrument set was feasible in all patients. Compared with the standard burr hole technique, accuracy was significantly higher both at entry (median 1.5 mm [range 0.2-3.2 mm] vs 1.7 mm [range 0.8-5.1 mm], p = 0.008) and at target (median 1.5 mm [range 0.4-3.4 mm] vs 2.0 mm [range 0.8-3.9 mm], p = 0.019). The incision-to-suture time was significantly shorter (median 30 minutes [range 15-50 minutes] vs 37.5 minutes [range 25-105 minutes], p < 0.001). The skin incision was significantly shorter (median 16.3 mm [range 12.7-23.4 mm] vs 28.4 mm [range 20-42.2 mm], p = 0.002). A diagnostic tissue sample was obtained in all cases. CONCLUSIONS Application of the novel instrument set was feasible in all patients. According to the authors' data, the minimally invasive robot-guidance procedure can significantly improve accuracy, reduce operating time, and improve the cosmetic result of stereotactic biopsies.
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Affiliation(s)
- Georgi Minchev
- 1Department of Neurosurgery, Medical University of Vienna
| | - Gernot Kronreif
- 2Austrian Center of Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria; and
| | - Wolfgang Ptacek
- 2Austrian Center of Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria; and
| | | | | | - Svenja Maschke
- 1Department of Neurosurgery, Medical University of Vienna
| | - Federico G Legnani
- 3Department of Neurosurgery, Fondazione IRCCS Instituto degli Neurologica C. Besta, Milan, Italy
| | - Georg Widhalm
- 1Department of Neurosurgery, Medical University of Vienna
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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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Giannakou M, Yiallouras C, Menikou G, Ioannides C, Damianou C. MRI-guided frameless biopsy robotic system with the inclusion of unfocused ultrasound transducer for brain cancer ablation. Int J Med Robot 2018; 15:e1951. [PMID: 30157310 DOI: 10.1002/rcs.1951] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND A magnetic resonance image (MRI) guided robotic system dedicated for brain biopsy was developed. The robotic system carries a biopsy needle and a small rectangular unfocused, single element, planar ultrasonic transducer which can be potentially utilized to ablate small and localized brain cancer. MATERIALS AND METHODS The robotic device includes six computer-controlled axes. An agar-based phantom was developed which included an olive that mimics brain target. A rectangular ultrasonic transducer operated at 4 MHz was used. RESULTS The functionality of the robotic system was assessed by means of ultrasound imaging, MRI imaging, and MR thermometry, demonstrating effective targeting. The heating capabilities of the ultrasonic transducer were also evaluated. CONCLUSIONS A functional MRI-guided robotic system was produced which can perform frameless brain biopsy. In the future, if a tumour is proven malignant, the needle can be pulled-out and a small ultrasonic transducer can be inserted to ablate the tumour.
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Affiliation(s)
- Marinos Giannakou
- Electrical Engineering Department, Cyprus University of Technology, Cyprus
| | | | - Georgios Menikou
- Department of Bioengineering, City University, London, UK.,R&D, MEDSONIC LTD, Limassol, Cyprus
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Busse H, Kahn T, Moche M. Techniques for Interventional MRI Guidance in Closed-Bore Systems. Top Magn Reson Imaging 2018; 27:9-18. [PMID: 29406410 DOI: 10.1097/rmr.0000000000000150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Efficient image guidance is the basis for minimally invasive interventions. In comparison with X-ray, computed tomography (CT), or ultrasound imaging, magnetic resonance imaging (MRI) provides the best soft tissue contrast without ionizing radiation and is therefore predestined for procedural control. But MRI is also characterized by spatial constraints, electromagnetic interactions, long imaging times, and resulting workflow issues. Although many technical requirements have been met over the years-most notably magnetic resonance (MR) compatibility of tools, interventional pulse sequences, and powerful processing hardware and software-there is still a large variety of stand-alone devices and systems for specific procedures only.Stereotactic guidance with the table outside the magnet is common and relies on proper registration of the guiding grids or manipulators to the MR images. Instrument tracking, often by optical sensing, can be added to provide the physicians with proper eye-hand coordination during their navigated approach. Only in very short wide-bore systems, needles can be advanced at the extended arm under near real-time imaging. In standard magnets, control and workflow may be improved by remote operation using robotic or manual driving elements.This work highlights a number of devices and techniques for different interventional settings with a focus on percutaneous, interstitial procedures in different organ regions. The goal is to identify technical and procedural elements that might be relevant for interventional guidance in a broader context, independent of the clinical application given here. Key challenges remain the seamless integration into the interventional workflow, safe clinical translation, and proper cost effectiveness.
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Affiliation(s)
- Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
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15
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Mohyeldin A, Elder JB. Stereotactic Biopsy Platforms with Intraoperative Imaging Guidance. Neurosurg Clin N Am 2017; 28:465-475. [DOI: 10.1016/j.nec.2017.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Tatsui CE, Nascimento CNG, Suki D, Amini B, Li J, Ghia AJ, Thomas JG, Stafford RJ, Rhines LD, Cata JP, Kumar AJ, Rao G. Image guidance based on MRI for spinal interstitial laser thermotherapy: technical aspects and accuracy. J Neurosurg Spine 2017; 26:605-612. [DOI: 10.3171/2016.9.spine16475] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVEImage guidance for spinal procedures is based on 3D-fluoroscopy or CT, which provide poor visualization of soft tissues, including the spinal cord. To overcome this limitation, the authors developed a method to register intraoperative MRI (iMRI) of the spine into a neuronavigation system, allowing excellent visualization of the spinal cord. This novel technique improved the accuracy in the deployment of laser interstitial thermal therapy probes for the treatment of metastatic spinal cord compression.METHODSPatients were positioned prone on the MRI table under general anesthesia. Fiducial markers were applied on the skin of the back, and a plastic cradle was used to support the MRI coil. T2-weighted MRI sequences of the region of interest were exported to a standard navigation system. A reference array was sutured to the skin, and surface matching of the fiducial markers was performed. A navigated Jamshidi needle was advanced until contact was made with the dorsal elements; its position was confirmed with intraoperative fluoroscopy prior to advancement into a target in the epidural space. A screenshot of its final position was saved, and then the Jamshidi needle was exchanged for an MRI-compatible access cannula. MRI of the exact axial plane of each access cannula was obtained and compared with the corresponding screenshot saved during positioning. The discrepancy in millimeters between the trajectories was measured to evaluate accuracy of the image guidanceRESULTSThirteen individuals underwent implantation of 47 laser probes. The median absolute value of the discrepancy between the location predicted by the navigation system and the actual position of the access cannulas was 0.7 mm (range 0–3.2 mm). No injury or adverse event occurred during the procedures.CONCLUSIONSThis study demonstrates the feasibility of image guidance based on MRI to perform laser interstitial thermotherapy of spinal metastasis. The authors' method permits excellent visualization of the spinal cord, improving safety and workflow during laser ablations in the epidural space. The results can be extrapolated to other indications, including biopsies or drainage of fluid collections near the spinal cord.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Juan P. Cata
- 6Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston; and
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Minchev G, Kronreif G, Martínez-Moreno M, Dorfer C, Micko A, Mert A, Kiesel B, Widhalm G, Knosp E, Wolfsberger S. A novel miniature robotic guidance device for stereotactic neurosurgical interventions: preliminary experience with the iSYS1 robot. J Neurosurg 2017; 126:985-996. [DOI: 10.3171/2016.1.jns152005] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Robotic devices have recently been introduced in stereotactic neurosurgery in order to overcome the limitations of frame-based and frameless techniques in terms of accuracy and safety. The aim of this study is to evaluate the feasibility and accuracy of the novel, miniature, iSYS1 robotic guidance device in stereotactic neurosurgery.
METHODS
A preclinical phantom trial was conducted to compare the accuracy and duration of needle positioning between the robotic and manual technique in 162 cadaver biopsies. Second, 25 consecutive cases of tumor biopsies and intracranial catheter placements were performed with robotic guidance to evaluate the feasibility, accuracy, and duration of system setup and application in a clinical setting.
RESULTS
The preclinical phantom trial revealed a mean target error of 0.6 mm (range 0.1–0.9 mm) for robotic guidance versus 1.2 mm (range 0.1–2.6 mm) for manual positioning of the biopsy needle (p < 0.001). The mean duration was 2.6 minutes (range 1.3–5.5 minutes) with robotic guidance versus 3.7 minutes (range 2.0–10.5 minutes) with manual positioning (p < 0.001). Clinical application of the iSYS1 robotic guidance device was feasible in all but 1 case. The median real target error was 1.3 mm (range 0.2–2.6 mm) at entry and 0.9 mm (range 0.0–3.1 mm) at the target point. The median setup and instrument positioning times were 11.8 minutes (range 4.2–26.7 minutes) and 4.9 minutes (range 3.1–14.0 minutes), respectively.
CONCLUSIONS
According to the preclinical data, application of the iSYS1 robot can significantly improve accuracy and reduce instrument positioning time. During clinical application, the robot proved its high accuracy, short setup time, and short instrument positioning time, as well as demonstrating a short learning curve.
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Affiliation(s)
- Georgi Minchev
- 1Department of Neurosurgery, Medical University of Vienna, Vienna; and
| | - Gernot Kronreif
- 2Austrian Center of Medical Innovation and Technology, Wiener Neustadt, Austria
| | | | - Christian Dorfer
- 1Department of Neurosurgery, Medical University of Vienna, Vienna; and
| | - Alexander Micko
- 1Department of Neurosurgery, Medical University of Vienna, Vienna; and
| | - Aygül Mert
- 1Department of Neurosurgery, Medical University of Vienna, Vienna; and
| | - Barbara Kiesel
- 1Department of Neurosurgery, Medical University of Vienna, Vienna; and
| | - Georg Widhalm
- 1Department of Neurosurgery, Medical University of Vienna, Vienna; and
| | - Engelbert Knosp
- 1Department of Neurosurgery, Medical University of Vienna, Vienna; and
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Mohyeldin A, Lonser RR, Elder JB. Real-time magnetic resonance imaging-guided frameless stereotactic brain biopsy: technical note. J Neurosurg 2015; 124:1039-46. [PMID: 26495951 DOI: 10.3171/2015.5.jns1589] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The object of this study was to assess the feasibility, accuracy, and safety of real-time MRI-compatible frameless stereotactic brain biopsy. METHODS Clinical, imaging, and histological data in consecutive patients who underwent stereotactic brain biopsy using a frameless real-time MRI system were analyzed. RESULTS Five consecutive patients (4 males, 1 female) were included in this study. The mean age at biopsy was 45.8 years (range 29-60 years). Real-time MRI permitted concurrent display of the biopsy cannula trajectory and tip during placement at the target. The mean target depth of biopsied lesions was 71.3 mm (range 60.4-80.4 mm). Targeting accuracy analysis revealed a mean radial error of 1.3 ± 1.1 mm (mean ± standard deviation), mean depth error of 0.7 ± 0.3 mm, and a mean absolute tip error of 1.5 ± 1.1 mm. There was no correlation between target depth and absolute tip error (Pearson product-moment correlation coefficient, r = 0.22). All biopsy cannulae were placed at the target with a single penetration and resulted in a diagnostic specimen in all cases. Histopathological evaluation of biopsy samples revealed dysembryoplastic neuroepithelial tumor (1 case), breast carcinoma (1 case), and glioblastoma multiforme (3 cases). CONCLUSIONS The ability to place a biopsy cannula under real-time imaging guidance permits on-the-fly alterations in the cannula trajectory and/or tip placement. Real-time imaging during MRI-guided brain biopsy provides precise safe targeting of brain lesions.
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Affiliation(s)
- Ahmed Mohyeldin
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - Russell R Lonser
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
| | - J Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio
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Kazanci A, Gurcan O, Gurcay A, Bozkurt I, Algin O, Turkoglu O, Bavbek M. A simple, safe and effective surface marking and targeting method combined with intraoperative ultrasonography for small subcortical intracranial lesions. J Neurosurg Sci 2015; 63:270-279. [PMID: 26173480 DOI: 10.23736/s0390-5616.16.03336-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Accurately locating small subcortical brain lesions is very important for maximal surgical resection with minimal neurological damage. Intraoperative MRI has proved to be more precise than ultrasound, it is relatively expensive and is not available in all centers. Herein we describe a new, simple, safe and effective method for determining a small skin incision and craniotomy via skin staples combined with intraoperative ultrasonography to determine the margins, vascularity and residue of the lesion. METHODS Thirty-three patients with small subcortical lesions were admitted into the study. The maximum diameter of the lesions ranged between 18 and 30 mm. The depth of the lesion was described as the distance between the cortical surface and most outer point of the lesion. The mean of the depth of the lesions was 10.56 mm ranging between 3.3 and 18.7 mm. Multiple skin staples were used as irremovable skin markers. Before and after dural incision, ultrasound was used to assess the lesion size and location, its relationship with the surrounding tissue and the Doppler function to reveal the blood supply to the lesion. RESULTS In this study mean craniotomy diameter was 44 mm ranging between 32-55 mm. The location, extent, characteristics and adjacent tissue of the lesion were observed by high frequency ultrasonography during the operation. CONCLUSIONS We describe a simple, safe and effective method for determining a small skin incision and craniotomy combined with intraoperative ultrasound for small subcortical intracranial lesions for health center that does not have intraoperative MRI and navigation systems.
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Affiliation(s)
- Atilla Kazanci
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey -
| | - Oktay Gurcan
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Ahmet Gurcay
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Ismail Bozkurt
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Oktay Algin
- Department of Radiology, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Omer Turkoglu
- Department of Neurosurgery, Ankara Ataturk Research and Training Hospital, Ankara, Turkey
| | - Murad Bavbek
- Department of Neurosurgery, School of Medicine, Yildirim Beyazit University, Ankara, Turkey
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20
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Lefranc M, Capel C, Pruvot-Occean AS, Fichten A, Desenclos C, Toussaint P, Le Gars D, Peltier J. Frameless robotic stereotactic biopsies: a consecutive series of 100 cases. J Neurosurg 2015; 122:342-52. [DOI: 10.3171/2014.9.jns14107] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECT
Stereotactic biopsy procedures are an everyday part of neurosurgery. The procedure provides an accurate histological diagnosis with the least possible morbidity. Robotic stereotactic biopsy needs to be an accurate, safe, frameless, and rapid technique. This article reports the clinical results of a series of 100 frameless robotic biopsies using a Medtech ROSA device.
METHODS
The authors retrospectively analyzed their first 100 frameless stereotactic biopsies performed with the robotic ROSA device: 84 biopsies were performed by frameless robotic surface registration, 7 were performed by robotic bone fiducial marker registration, and 9 were performed by scalp fiducial marker registration. Intraoperative flat-panel CT scanning was performed concomitantly in 25 cases. The operative details of the robotic biopsies, the diagnostic yield, and mortality and morbidity data observed in this series are reported.
RESULTS
A histological diagnosis was established in 97 patients. No deaths or permanent morbidity related to surgery were observed. Six patients experienced transient neurological worsening. Six cases of bleeding within the lesion or along the biopsy trajectory were observed on postoperative CT scans but were associated with transient clinical symptoms in only 2 cases. Stereotactic surgery was performed with patients in the supine position in 93 cases and in the prone position in 7 cases. The use of fiducial markers was reserved for posterior fossa biopsy via a transcerebellar approach, via an occipital approach, or for pediatric biopsy.
CONCLUSIONS
ROSA frameless stereotactic biopsies appear to be accurate and safe robotized frameless procedures.
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Sun X, Chen Z, Yang S, Zhang J, Yue S, Wang Z, Yang W. Role of high-field intraoperative magnetic resonance imaging on a multi-image fusion-guided stereotactic biopsy of the basal ganglia: A case report. Oncol Lett 2014; 9:223-226. [PMID: 25435963 PMCID: PMC4246638 DOI: 10.3892/ol.2014.2680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 10/15/2014] [Indexed: 11/06/2022] Open
Abstract
The aim of the present case study was to investigate the advantages of intraoperative magnetic resonance imaging (iMRI) on the real-time guidance and monitoring of a stereotactic biopsy. The study describes a patient with intracranial lesions, which were examined by conventional MRI and diffusion tensor imaging using a 1.5T intraoperative MRI system. The digital and pre-operative positron emission/computed tomography image data were transferred to a BrainLAB planning workstation, and a variety of images were automatically fused. The BrainLAB software was then used to reconstruct the corticospinal tract (CST) and create a three-dimensional display of the anatomical association between the CST and the brain lesions. A Leksell surgical planning workstation was used to identify the ideal target site and a reasonable needle track for the biopsy. The 1.5T iMRI was used to effectively monitor the intracranial condition during the brain biopsy procedure. Post-operatively, the original symptoms of the patient were not aggravated and no further neurological deficits were apparent. The histopathological diagnosis of non-Hodgkin's B-cell lymphoma was made. Using high-field iMRI, the multi-image fusion-guided stereotactic brain biopsy allows for a higher positive rate of biopsy and a lower incidence of complications. The approach of combining multi-image fusion images with the frame-based stereotactic biopsy may be clinically useful for intracranial lesions of deep functional areas.
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Affiliation(s)
- Xiang Sun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Zhijuan Chen
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Shuyuan Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Shuyuan Yue
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Zengguang Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Weidong Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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Broggi M, Broggi G. Stereotactic biopsy: an established procedure, but still modern? The importance of brain biopsies procedures. World Neurosurg 2014; 83:285-7. [PMID: 25195107 DOI: 10.1016/j.wneu.2014.08.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 08/29/2014] [Indexed: 11/15/2022]
Affiliation(s)
- Morgan Broggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Giovanni Broggi
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
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Lu Y, Yeung C, Radmanesh A, Wiemann R, Black PM, Golby AJ. Comparative effectiveness of frame-based, frameless, and intraoperative magnetic resonance imaging-guided brain biopsy techniques. World Neurosurg 2014; 83:261-8. [PMID: 25088233 DOI: 10.1016/j.wneu.2014.07.043] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 02/09/2014] [Accepted: 07/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the diagnostic yield and safety profiles of intraoperative magnetic resonance imaging (MRI)-guided needle brain biopsy with 2 traditional brain biopsy methods: frame-based and frameless stereotactic brain biopsy. METHODS A retrospective analysis was performed of 288 consecutive needle brain biopsies in 277 patients undergoing stereotactic brain biopsy with any of the 3 biopsy methods at Brigham and Women's Hospital from 2000-2008. Variables including age, sex, history of radiation and previous surgery, pathology results, complications, and postoperative length of hospital stay were analyzed. RESULTS Over the course of 8 years, 288 brain biopsies were performed. Of these, 253 (87.8%) biopsies yielded positive diagnostic tissue. Young age (<40 years old) and history of brain radiation or surgery were significant negative predictors for a positive biopsy diagnostic yield. Excluding patients with prior radiation or surgeries, no significant difference in diagnostic yield was detected among the 3 groups, with frame-based biopsies yielding 96.9%, frameless biopsies yielding 91.8%, and intraoperative MRI-guided needle biopsies yielding 89.9% positive diagnostic yield. Serious adverse events occurred 19 biopsies (6.6%). Intraoperative MRI-guided brain biopsies were associated with less serious adverse events and the shortest postoperative hospital stay. CONCLUSIONS Frame-based, frameless stereotactic, and intraoperative MRI-guided brain needle biopsy techniques have comparable diagnostic yield for patients with no prior treatments (either radiation or surgery). Intraoperative MRI-guided brain biopsy is associated with fewer serious adverse events and shorter hospital stay.
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Affiliation(s)
- Yi Lu
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Cecil Yeung
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alireza Radmanesh
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Wiemann
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter M Black
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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25
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Orringer DA, Golby A, Jolesz F. Neuronavigation in the surgical management of brain tumors: current and future trends. Expert Rev Med Devices 2013; 9:491-500. [PMID: 23116076 DOI: 10.1586/erd.12.42] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neuronavigation has become an ubiquitous tool in the surgical management of brain tumors. This review describes the use and limitations of current neuronavigational systems for brain tumor biopsy and resection. Methods for integrating intraoperative imaging into neuronavigational datasets developed to address the diminishing accuracy of positional information that occurs over the course of brain tumor resection are discussed. In addition, the process of integration of functional MRI and tractography into navigational models is reviewed. Finally, emerging concepts and future challenges relating to the development and implementation of experimental imaging technologies in the navigational environment are explored.
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Affiliation(s)
- Daniel A Orringer
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Poliachik SL, Poliakov AV, Jansen LA, McDaniel SS, Wray CD, Kuratani J, Saneto RP, Ojemann JG, Novotny EJ. Tissue localization during resective epilepsy surgery. Neurosurg Focus 2013; 34:E8. [DOI: 10.3171/2013.3.focus1360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Imaging-guided surgery (IGS) systems are widely used in neurosurgical practice. During epilepsy surgery, the authors routinely use IGS landmarks to localize intracranial electrodes and/or specific brain regions. The authors have developed a technique to coregister these landmarks with pre- and postoperative scans and the Montreal Neurological Institute (MNI) standard space brain MRI to allow 1) localization and identification of tissue anatomy; and 2) identification of Brodmann areas (BAs) of the tissue resected during epilepsy surgery. Tracking tissue in this fashion allows for better correlation of patient outcome to clinical factors, functional neuroimaging findings, and pathological characteristics and molecular studies of resected tissue.
Methods
Tissue samples were collected in 21 patients. Coordinates from intraoperative tissue localization were downloaded from the IGS system and transformed into patient space, as defined by preoperative high-resolution T1-weighted MRI volume. Tissue landmarks in patient space were then transformed into MNI standard space for identification of the BAs of the tissue samples.
Results
Anatomical locations of resected tissue were identified from the intraoperative resection landmarks. The BAs were identified for 17 of the 21 patients. The remaining patients had abnormal brain anatomy that could not be meaningfully coregistered with the MNI standard brain without causing extensive distortion.
Conclusions
This coregistration and landmark tracking technique allows localization of tissue that is resected from patients with epilepsy and identification of the BAs for each resected region. The ability to perform tissue localization allows investigators to relate preoperative, intraoperative, and postoperative functional and anatomical brain imaging to better understand patient outcomes, improve patient safety, and aid in research.
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Affiliation(s)
- Sandra L. Poliachik
- 1Divisions of Pediatric Neurology,
- 2Pediatric Radiology, and
- 6Centers for Clinical and Translational Research and
| | - Andrew V. Poliakov
- 2Pediatric Radiology, and
- 3Pediatric Neurosurgery, Seattle Children's Hospital
| | - Laura A. Jansen
- 4Departments of Neurology and
- 7Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
| | | | - Carter D. Wray
- 1Divisions of Pediatric Neurology,
- 4Departments of Neurology and
| | - John Kuratani
- 1Divisions of Pediatric Neurology,
- 4Departments of Neurology and
- 6Centers for Clinical and Translational Research and
| | - Russell P. Saneto
- 1Divisions of Pediatric Neurology,
- 4Departments of Neurology and
- 6Centers for Clinical and Translational Research and
| | - Jeffrey G. Ojemann
- 3Pediatric Neurosurgery, Seattle Children's Hospital
- 5Neurosurgery, and
- 7Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
- 8Integrative Brain Imaging Center, University of Washington; and
| | - Edward J. Novotny
- 1Divisions of Pediatric Neurology,
- 4Departments of Neurology and
- 7Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington
- 8Integrative Brain Imaging Center, University of Washington; and
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Larson PS, Starr PA, Bates G, Tansey L, Richardson RM, Martin AJ. An optimized system for interventional magnetic resonance imaging-guided stereotactic surgery: preliminary evaluation of targeting accuracy. Neurosurgery 2012; 70:95-103; discussion 103. [PMID: 21796000 DOI: 10.1227/neu.0b013e31822f4a91] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Deep brain stimulation electrode placement with interventional magnetic resonance imaging (MRI) has previously been reported using a commercially available skull-mounted aiming device (Medtronic Nexframe MR) and native MRI scanner software. This first-generation method has technical limitations that are inherent to the hardware and software used. A novel system (SurgiVision ClearPoint) consisting of an aiming device (SMARTFrame) and software has been developed specifically for interventional MRI, including deep brain stimulation. OBJECTIVE To report a series of phantom and cadaver tests performed to determine the capability, preliminary accuracy, and workflow of the system. METHODS Eighteen experiments using a water phantom were used to determine the predictive accuracy of the software. Sixteen experiments using a gelatin-filled skull phantom were used to determine targeting accuracy of the aiming device. Six procedures in 3 cadaver heads were performed to compare the workflow and accuracy of ClearPoint with Nexframe MR. RESULTS Software prediction experiments showed an average error of 0.9 ± 0.5 mm in magnitude in pitch and roll (mean pitch error, -0.2 ± 0.7 mm; mean roll error, 0.2 ± 0.7 mm) and an average error of 0.7 ± 0.3 mm in X-Y translation with a slight anterior (0.5 ± 0.3 mm) and lateral (0.4 ± 0.3 mm) bias. Targeting accuracy experiments showed an average radial error of 0.5 ± 0.3 mm. Cadaver experiments showed a radial error of 0.2 ± 0.1 mm with the ClearPoint system (average procedure time, 88 ± 14 minutes) vs 0.6 ± 0.2 mm with the Nexframe MR (average procedure time, 92 ± 12 minutes). CONCLUSION This novel system provides the submillimetric accuracy required for stereotactic interventions, including deep brain stimulation placement. It also overcomes technical limitations inherent in the first-generation interventional MRI system.
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Affiliation(s)
- Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143-0112, USA.
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Ostrem JL, Galifianakis NB, Markun LC, Grace JK, Martin AJ, Starr PA, Larson PS. Clinical outcomes of PD patients having bilateral STN DBS using high-field interventional MR-imaging for lead placement. Clin Neurol Neurosurg 2012; 115:708-12. [PMID: 22944465 DOI: 10.1016/j.clineuro.2012.08.019] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/05/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Recently, an iMRI-guided technique for implanting DBS electrodes without MER was developed at our center. Here we report the clinical outcomes of PD patients undergoing STN DBS surgery using this surgical approach. METHODS Consecutive PD patients undergoing bilateral STN DBS using this method were prospectively studied. Severity of PD was determined using the UPDRS scores, Hoehn and Yahr staging score, stand-sit-walk testing, and the dyskinesia rating scale. The primary outcome measure was the change in UPDRS III off medication score at 6 months. DBS stimulation parameters, adverse events, levodopa equivalent daily dose (LEDD), and DBS lead locations were also recorded. Seventeen advanced PD patients (9M/8F) were enrolled from 2007 to 2009. RESULTS The mean UPDRS III off medication score improved from 44.5 to 22.5 (49.4%) at 6 months (p=0.001). Other secondary outcome measures (UPDRS II, III on medication, and IV) significantly improved as well (p<0.01). LEDD decreased by an average of 24.7% (p=0.003). Average stimulation parameters were: 2.9V, 66.4μs, 154Hz. CONCLUSION This pilot study demonstrates that STN DBS leads placed using the iMRI-guided method results in significantly improved outcomes in PD symptoms, and these outcomes are similar to what has been reported using traditional frame-based, MER-guided stereotactic methods.
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Affiliation(s)
- Jill L Ostrem
- Department of Neurology, University of California, San Francisco, Surgical Movement Disorders, 1635 Divisadero Street, 5th Floor, Suites 520-530, San Francisco, CA 94115, USA.
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Bekelis K, Radwan TA, Desai A, Roberts DW. Frameless robotically targeted stereotactic brain biopsy: feasibility, diagnostic yield, and safety. J Neurosurg 2012; 116:1002-6. [DOI: 10.3171/2012.1.jns111746] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Frameless stereotactic brain biopsy has become an established procedure in many neurosurgical centers worldwide. Robotic modifications of image-guided frameless stereotaxy hold promise for making these procedures safer, more effective, and more efficient. The authors hypothesized that robotic brain biopsy is a safe, accurate procedure, with a high diagnostic yield and a safety profile comparable to other stereotactic biopsy methods.
Methods
This retrospective study included 41 patients undergoing frameless stereotactic brain biopsy of lesions (mean size 2.9 cm) for diagnostic purposes. All patients underwent image-guided, robotic biopsy in which the SurgiScope system was used in conjunction with scalp fiducial markers and a preoperatively selected target and trajectory. Forty-five procedures, with 50 supratentorial targets selected, were performed.
Results
The mean operative time was 44.6 minutes for the robotic biopsy procedures. This decreased over the second half of the study by 37%, from 54.7 to 34.5 minutes (p < 0.025). The diagnostic yield was 97.8% per procedure, with a second procedure being diagnostic in the single nondiagnostic case. Complications included one transient worsening of a preexisting deficit (2%) and another deficit that was permanent (2%). There were no infections.
Conclusions
Robotic biopsy involving a preselected target and trajectory is safe, accurate, efficient, and comparable to other procedures employing either frame-based stereotaxy or frameless, nonrobotic stereotaxy. It permits biopsy in all patients, including those with small target lesions. Robotic biopsy planning facilitates careful preoperative study and optimization of needle trajectory to avoid sulcal vessels, bridging veins, and ventricular penetration.
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Affiliation(s)
| | | | | | - David W. Roberts
- 1Section of Neurosurgery and
- 2Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon; and
- 3Dartmouth Medical School, Hanover, New Hampshire
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5-Aminolevulinic acid-induced protoporphyrin IX fluorescence as immediate intraoperative indicator to improve the safety of malignant or high-grade brain tumor diagnosis in frameless stereotactic biopsies. Acta Neurochir (Wien) 2012; 154:585-8; discussion 588. [PMID: 22297399 PMCID: PMC3308005 DOI: 10.1007/s00701-012-1290-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 01/19/2012] [Indexed: 11/13/2022]
Abstract
Background Frameless stereotactic biopsies are replacing frame-based stereotaxy as a diagnostic approach to brain lesions. In order to avoid a sampling bias or negative histology, multiple specimens are often taken. This in turn increases the risk of hemorrhagic complications. Objective We present the use of 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX fluorescence in frameless stereotaxy to improve the procedure duration and yield, and thereby reduce the risk of complications. Methods Patients with suspected high-grade brain tumors are given 5-ALA 4 h prior to stereotactic biopsy. The biopsy needle is guided to the target using frameless stereotaxy based either on preoperative images or combined with intraoperative MRI sequences. The specimen is illuminated with blue light to look for fluorescence. In case of a positive fluorescence within the tissue sample, no frozen sections are obtained, and no further specimens are taken. Results The samples of 13 patients revealed a positive fluorescence and were histologically confirmed as malignant or high-grade brain neoplasms. four cases were fluorescence-negative, requiring frozen section confirmation and/or multiple samples. In theses cases histology was either nonspecific gliotic changes or low-grade tumors. There were no complications related to the additional use of 5-ALA. Conclusion 5-ALA fluorescence in stereotactic biopsies can increase the safety and accuracy of these procedures by reducing sampling errors and eliminating the need for multiple samples and/or frozen section verification, creating a more accurate, faster and safer procedure for cases of suspected malignant or high-grade brain tumors situated in deep or eloquent areas.
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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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32
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Quinn J, Spiro D, Schulder M. Stereotactic brain biopsy with a low-field intraoperative magnetic resonance imager. Neurosurgery 2011; 68:217-24; discussion 224. [PMID: 21206306 DOI: 10.1227/neu.0b013e31820826c2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Techniques for stereotactic brain biopsy have evolved in parallel with the imaging modalities used to visualize the brain. OBJECTIVE To describe our technique for performing stereotactic brain biopsy using a compact, low-field, intraoperative magnetic resonance imager (iMRI). METHODS Thirty-three patients underwent stereotactic brain biopsies with the PoleStar N-20 iMRI system (Medtronic Navigation, Louisville, Colorado). Preoperative iMRI scans were obtained for biopsy target identification and trajectory planning. A skull-mounted device (Navigus, Medtronic Navigation) was used to guide an MRI-compatible cannula to the target. An intraoperative image was acquired to confirm accurate cannula placement within the lesion. Serial images were obtained to track cannula movement and to rule out hemorrhage. Frozen sections were obtained in all but 1 patient with a brain abscess. RESULTS Diagnostic tissue was obtained in 32 of 33 patients. In all cases, imaging demonstrated cannula placement within the lesion. Histological diagnoses included 22 primary brain tumors and 10 nonneoplastic lesions. In 61% of the cases, initial trajectory was corrected on the basis of the intraoperative scans. In 1 patient, biopsy was nondiagnostic despite accurate cannula placement. No patient suffered a clinically or radiographically significant hemorrhage during or after surgery. There were no intraoperative complications. CONCLUSION Stereotactic biopsy with a low-field iMRI is an accurate way to obtain specimens with a high diagnostic yield. This accuracy, combined with the acceptable additional procedural time, may obviate the need for frozen section. The ability to correct biopsy cannula placement during surgery eliminates the chance of misdiagnosis because of faulty targeting, as well as the risks associated with inconclusive frozen sections and "blind" replacement of the cannula.
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Affiliation(s)
- John Quinn
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
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Colen RR, Kekhia H, Jolesz FA. Multimodality intraoperative MRI for brain tumor surgery. Expert Rev Neurother 2011; 10:1545-58. [PMID: 20945538 DOI: 10.1586/ern.10.145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intraoperative MRI has already fundamentally changed the way current brain tumor surgery is performed. The ability to integrate high-field MRI into the operating room has allowed intraoperative MRI to emerge as an important adjunct to CNS tumor treatment. Furthermore, the ability of MRI to successfully couple with molecular imaging (PET and/or optical imaging), neuroendoscopy and therapeutic devices, such as focused ultrasound, will allow it to emerge as an important image-guidance modality for improving brain tumor therapy and outcomes.
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Affiliation(s)
- Rivka R Colen
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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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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Black P, Jolesz FA, Medani K. From vision to reality: the origins of intraoperative MR imaging. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 109:3-7. [PMID: 20960313 DOI: 10.1007/978-3-211-99651-5_1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intraoperative MR imaging has become one of the most important concepts in present day neurosurgery. The brain shift problem with navigation, the need for assessment of the degree of resection and the need for detection of early postoperative complications were the three most important motives that drove the development of this technology. The GE Signa System with the "double doughnut" design was the world's first intraoperative MRI. From 1995 to 2007 more than 1,000 neurosurgical cases were performed with the system. The system was used by several different specialties and in neurosurgery it was most useful for complete resection of low-grade gliomas, identification and resection of small or deep metastases or cavernomas, recurrent pituitary adenomas, cystic tumors, biopsies in critical areas and surgery in recurrent GBM cases. Main superiorities of the system were the ability to scan without patient movement to get image updates, the ability to do posterior fossa cases and other difficult patient positioning, the easiness of operation using intravenous sedation anesthesia and the flexibility of the system to be used as platform for new diagnostic and therapeutic modalities.
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Affiliation(s)
- Peter Black
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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36
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Moriarty TM, Titsworth WL. The evolution of iMRI utilization for pediatric neurosurgery: a single center experience. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 109:89-94. [PMID: 20960326 DOI: 10.1007/978-3-211-99651-5_14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
From its inception intraoperative magnetic resonance imaging (ioMRI) was envisioned to have significant applications in neurosurgery in general and pediatrics specifically. Over the last 9 years we have noted a dramatic shift in our ioMRI usage from intracranial tumors to cerebrospinal fluid management and complex cysts. Here we present seven selected cases to illustrate lessons learned from our operative experience within the GE Signa SP/I open-configuration "double-doughnut" MRI. These cases including a ganglioglioma, ependymoma, and pilocytic astrocytoma tumor resection, as well as arachnoid cysts, complex cyst, and microabscess drainage reflect our current use of ioMRI in pediatric neurosurgical cases. Namely that ioMRI is optimal for (1) resection of small tumors with poorly differentiated tumor margins, (2) large tumors with mass effect, and (3) shunt or catheter placement requiring either extreme accuracy or intraoperative confirmation of catheter placement. We also comment on the legitimate limitations of this technology in certain operations. Additionally emphasized are cases in which ioMRI imaging drives operative decision making, highlighting the unique and unequaled abilities of this technology for a subset of pediatric neurosurgical cases.
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Affiliation(s)
- Thomas M Moriarty
- Kosair Children's Hospital, Norton Neuroscience Institute, 210 E Gray St.Suite 1105, Louisville, KY 40202, USA.
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Starr PA, Martin AJ, Ostrem JL, Talke P, Levesque N, Larson PS. Subthalamic nucleus deep brain stimulator placement using high-field interventional magnetic resonance imaging and a skull-mounted aiming device: technique and application accuracy. J Neurosurg 2010; 112:479-90. [PMID: 19681683 DOI: 10.3171/2009.6.jns081161] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors discuss their method for placement of deep brain stimulation (DBS) electrodes using interventional MR (iMR) imaging and report on the accuracy of the technique, its initial clinical efficacy, and associated complications in a consecutive series of subthalamic nucleus (STN) DBS implants to treat Parkinson disease (PD). METHODS A skull-mounted aiming device (Medtronic NexFrame) was used in conjunction with real-time MR imaging (Philips Intera 1.5T). Preoperative imaging, DBS implantation, and postimplantation MR imaging were integrated into a single procedure performed with the patient in a state of general anesthesia. Accuracy of implantation was assessed using 2 types of measurements: the "radial error," defined as the scalar distance between the location of the intended target and the actual location of the guidance sheath in the axial plane 4 mm inferior to the commissures, and the "tip error," defined as the vector distance between the expected anterior commissure-posterior commissure (AC-PC) coordinates of the permanent DBS lead tip and the actual AC-PC coordinates of the lead tip. Clinical outcome was assessed using the Unified Parkinson's Disease Rating Scale part III (UPDRS III), in the off-medication state. RESULTS Twenty-nine patients with PD underwent iMR imaging-guided placement of 53 DBS electrodes into the STN. The mean (+/- SD) radial error was 1.2 +/- 0.65 mm, and the mean absolute tip error was 2.2 +/- 0.92 mm. The tip error was significantly smaller than for STN DBS electrodes implanted using traditional frame-based stereotaxy (3.1 +/- 1.41 mm). Eighty-seven percent of leads were placed with a single brain penetration. No hematomas were visible on MR images. Two device infections occurred early in the series. In bilaterally implanted patients, the mean improvement on the UPDRS III at 9 months postimplantation was 60%. CONCLUSIONS The authors' technical approach to placement of DBS electrodes adapts the procedure to a standard configuration 1.5-T diagnostic MR imaging scanner in a radiology suite. This method simplifies DBS implantation by eliminating the use of the traditional stereotactic frame and the subsequent requirement for registration of the brain in stereotactic space and the need for physiological recording and patient cooperation. This method has improved accuracy compared with that of anatomical guidance using standard frame-based stereotaxy in conjunction with preoperative MR imaging.
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Affiliation(s)
- Philip A Starr
- Department of Neurosurgery, University of California, San Francisco, California 94143, USA.
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Air EL, Leach JL, Warnick RE, McPherson CM. Comparing the risks of frameless stereotactic biopsy in eloquent and noneloquent regions of the brain: a retrospective review of 284 cases. J Neurosurg 2009; 111:820-4. [DOI: 10.3171/2009.3.jns081695] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Object
Frameless stereotactic biopsy has been shown in multiple studies to be a safe and effective tool for the diagnosis of brain lesions. However, no study has directly evaluated its safety in lesions located in eloquent regions in comparison with noneloquent locations. In this study, the authors determine whether an increased risk of neurological decline is associated with biopsy of lesions in eloquent regions of the brain.
Methods
Medical records, including imaging studies, were reviewed for 284 cases in which frameless stereotactic biopsy procedures were performed by 19 neurosurgeons at 7 institutions between January 2000 and December 2006. Lesion location was classified as eloquent or noneloquent in each patient. The incidence of neurological decline was calculated for each group.
Results
During the study period, 160 of the 284 biopsies predominately involved eloquent regions of the brain. In evaluation of the complication rate with respect to biopsy site, neurological decline occurred in 9 (5.6%) of 160 biopsies in eloquent brain areas and 10 (8.1%) of 124 biopsies in noneloquent regions; this difference was not statistically significant (p = 0.416). A higher number of needle passes was associated with the presence of a postoperative hemorrhage at the biopsy site, although not with a change in the result of neurological examination.
Conclusions
Frameless stereotactic biopsy of lesions located in eloquent brain regions is as safe and effective as biopsy of lesions in noneloquent regions. Therefore, with careful planning, frameless stereotactic biopsy remains a valuable and safe tool for diagnosis of brain lesions, independent of lesion location.
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Affiliation(s)
| | - James L. Leach
- 2Radiology, Brain Tumor Center at the University of Cincinnati Neuroscience Institute and University of Cincinnati College of Medicine
- 3Department of Radiology, Cincinnati Children's Hospital Medical Center; and
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Abstract
Intraoperative and interventional MR have opened a new chapter in neurosurgery bringing both new therapeutic opportunities and creating unique safety challenges for the MR operating room. The presence of a large magnetic field in the otherwise familiar environment of the operating room necessitates site-specific comprehensive policies for safety, staff training, infection control, and MR compatibility. Intraoperative MRI also creates unique MR image interpretation challenges that are of paramount significance for patient safety. These safety concerns are reviewed with particular reference to the nine years experience of the authors.
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Affiliation(s)
- Thomas Johnston
- Department of Neurological Surgery, University of Louisville, 210 East Gray Street, Suite 1102, Louisville, KY 40202, USA
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40
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Abstract
Currently, neuronavigation is an indivisible and indispensable part of the neurosurgical reality with a significant potential impact in each neurosurgical procedure. The history of neuronavigation is quite short (< 3 decades), but full of highly promising achievements. The advent of neuronavigation would be unimaginable without the development of imaging technology, electronics, robotics, and space technology. The history of neuroradiology is reviewed briefly parallel with the detailed evolution of frame-based stereotaxy and its successor—neuronavigation. The historic milestones and the state of the art of neuronavigation are discussed in a genealogical manner. The future trends of neuronavigation as integrated with intraoperative CT, MR, and ultrasonography, as well as with robotic systems are outlined.
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41
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Foroglou N, Zamani A, Black P. Intra-operative MRI (iop-MR) for brain tumour surgery. Br J Neurosurg 2009; 23:14-22. [DOI: 10.1080/02688690802610587] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Shastri-Hurst N, Tsegaye M, Robson DK, Lowe JS, Macarthur DC. Stereotactic brain biopsy: an audit of sampling reliabilityin a clinical case series. Br J Neurosurg 2009; 20:222-6. [PMID: 16954072 DOI: 10.1080/02688690600875507] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Stereotactic brain biopsy is the current gold standard procedure to obtain a neuropathological diagnosis. An audit of 207 stereotactic cases, between January 1997 and December 2000 was carried out. The aim was to determine the optimum number of target sites required to make the final diagnosis and thereby set up recommendations for future practice. The overall diagnostic success rate was 89.3%. A significant positive correlation between the number of targets taken and the probability of achieving the final diagnosis was seen. In a subset of glioblastoma cases 96.1% of the tumours could have been confidently diagnosed on the basis of any two of the targets chosen, although often more targets were taken than this. The recommendations made by the audit were: (i) in cases where it is suspected the lesion does not require grading, one target site should be taken and further sites should only be taken if the first proves to be non diagnostic; (ii) in suspected glial series tumours, two targets should be routinely taken, with further sites taken only if these prove inconclusive on intraoperative smear.
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Affiliation(s)
- N Shastri-Hurst
- Department of Neuropathology, University Hospital, Queen's Medical Centre, Nottingham, UK
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43
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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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Moche M, Trampel R, Kahn T, Busse H. Navigation concepts for MR image-guided interventions. J Magn Reson Imaging 2008; 27:276-91. [DOI: 10.1002/jmri.21262] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Quiñones-Hinojosa A, McDermott MW. Angled screw holes for anterior posts and a frame-positioning device for gamma knife radiosurgery: allowing for better targeting of intracranial lesions. Neurosurgery 2007; 60:339-43; discussion 343-4. [PMID: 17415172 DOI: 10.1227/01.neu.0000255355.02195.d1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Gamma knife radiosurgery requires frame positioning so that the treatment target is as close to the center of the frame and as low as possible to cover all of the posterior fossa contents. In this study, we report the use of two devices developed by the senior author (MWM) that facilitate these two crucial objectives in the treatment of intracranial targets using the gamma knife. METHODS Custom front posts with threaded screw holes drilled at 5-, 10-, and 15-degree angles were created by the manufacturer at our request. A U-shaped metal device for frame positioning was designed in-house and fits into the holes at the 100-mm mark on the lateral sides of the Leksell stereotactic frame base. This allowed the positioning device to snap securely into the frame for use in positioning. The positioning device was constructed so that the lowest possible frame position would be achieved with each frame application, while avoiding collisions with the magnetic resonance imaging localizer box. RESULTS Angled front posts allowed for pin contacts with the cranium anterior and/or superior to the superior temporal line despite a lateral or posterior position of the frame. This avoided penetration of the temporalis muscle and reduced discomfort for patients. The U-shaped metal device was used in place of the Velcro straps or ear bars routinely used for frame positioning in which the distance from the frame base to the top of the head must always be measured to avoid collisions with the localizer box. During the past 2 years, these devices have been used on a daily basis, achieving the desired results. In many cases, their use has avoided the need for frame repositioning and rescanning for targets that cannot be reached because of inexact frame positioning. CONCLUSION A new design with angled screw holes in the front posts used for gamma knife radiosurgery allows surgeons to avoid penetration of the temporalis muscle and to maintain a perpendicular orientation of the fixation screw to the outer table of the cranium. They may also prevent mechanical creep caused by the obliquity of pin contact with the cranium and resulting loss of torque. We also present a simple device that may be useful in frame positioning. The device ensures a frame position as low as possible without the need for measurement at the time of frame positioning.
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Salas S, Brimacombe M, Schulder M. Stereotactic accuracy of a compact intraoperative MRI system. Stereotact Funct Neurosurg 2006; 85:69-74. [PMID: 17167234 DOI: 10.1159/000097921] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the stereotactic accuracy of the PoleStar N-20, a compact intraoperative magnetic resonance imaging (iMRI) system, based on a 0.15-Tesla (T) magnet. METHODS An MRI-compatible phantom was scanned after being positioned in both the center of the magnetic field (COF) and the periphery of the field (POF) of the PoleStar N-20 magnet. Scans were acquired at various slice thicknesses in 3 sequences: T(1) weighted, T(2) weighted and Esteady (reversed fast imaging with steady-state precession, also known as 'PSIF'). The distance between the actual location of the probe tip in space and the location of the target on the image was measured on the axial, coronal, and sagittal planes for 9 points on each image. Each measurement was repeated 3 times. We also compared the structural features of the PoleStar N-20 to those of its predecessor. RESULTS T(1)-weighted scans yielded the most accurate measurements. There was no statistically significant difference between scans acquired at thicknesses of 2, 3, 4 and 8 mm; all were accurate for clinical purposes. Comparison of COF with POF measurements using T(1)-weighted scans did not demonstrate a statistically significant difference in accuracy. CONCLUSIONS The PoleStar N-20 0.15-T iMRI system provides surgical navigation that is at least as accurate as the first generation model of this system, which employed a 0.12-T magnet. Further analysis of stereotactic accuracy on clinical cases using the PoleStar N-20 is needed to confirm that these results will bear out in surgical reality.
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Affiliation(s)
- Sussan Salas
- Department of Neurological Surgery, New Jersey Medical School, Newark, NJ 07103, USA
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Unsgaard G, Rygh OM, Selbekk T, Müller TB, Kolstad F, Lindseth F, Hernes TAN. Intra-operative 3D ultrasound in neurosurgery. Acta Neurochir (Wien) 2006; 148:235-53; discussion 253. [PMID: 16362178 DOI: 10.1007/s00701-005-0688-y] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 10/06/2005] [Indexed: 11/29/2022]
Abstract
In recent years there has been a considerable improvement in the quality of ultrasound (US) imaging. The integration of 3D US with neuronavigation technology has created an efficient and inexpensive tool for intra-operative imaging in neurosurgery. In this review we present the technological background and an overview of the wide range of different applications. The technology has so far mostly been applied to improve surgery of tumours in brain tissue, but it has also been found to be useful in other procedures such as operations for cavernous haemangiomas, skull base tumours, syringomyelia, medulla tumours, aneurysms, AVMs and endoscopy guidance.
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Affiliation(s)
- G Unsgaard
- Department of Neurosurgery, St. Olav University Hospital, Trondheim, Norway.
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Pamir MN, Peker S, Ozek MM, Dinçer A. Intraoperative MR imaging: preliminary results with 3 tesla MR system. ACTA NEUROCHIRURGICA. SUPPLEMENT 2006; 98:97-100. [PMID: 17009706 DOI: 10.1007/978-3-211-33303-7_13] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
UNLABELLED Aim of this study is to present the initial clinical experience with 3 tesla intraoperative MR (ioMR). MATERIAL AND METHODS The 3T MRI suite is built adjacent to the neurosurgical operation theatre. The magnet room and the operation theatre are interconnected by a door and both RF-shielded. Before the operation, the magnet (3T Trio, Siemens) and the console rooms are disinfected. Whenever imaging is needed during the operation, the door is opened and the patient is transferred from the operation table to the magnet cradle. Axial, sagittal and/or coronal TSE T2, SE T1 and 3D Flash T1 weighted images (4-6 mm section thickness, 1 mm interslice gap) are obtained according to the lesion. Total examination time is approximately 10 minutes. RESULTS Twenty-six patients were examined with ioMR. There were ten female and seven male patients. Lesions were pituitary adenoma in 10, low grade glial tumor in 9, meningioma and high grade glial tumor in 2 each and metastasis, haemangioblastoma and chordoma in one each. Follow-up time was 1 to 9 months. In 16 patients the first intraoperative examination revealed gross total tumor excision. However, in 10 patients due to tumor remnants surgical intervention was continued and a second examination revealed gross total tumor excision in all. Postoperative routine MR examinations confirmed total tumor excision in all patients. No complication occurred in this series. CONCLUSION This small group of patients examined with ioMR demonstrated that the procedure is simple, helpful in achieving gross total tumor excision without complications.
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Affiliation(s)
- M N Pamir
- Marmara University, Department of Neurosurgery, Neurological Sciences Institute, and Acibadem Health Group Kozyatagi Hospital, Istanbul, Turkey.
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Quiñones-Hinojosa A, Ware ML, Sanai N, McDermott MW. Assessment of Image Guided Accuracy in a Skull Model: Comparison of Frameless Stereotaxy Techniques vs. Frame-Based Localization. J Neurooncol 2005; 76:65-70. [PMID: 16132501 DOI: 10.1007/s11060-005-2915-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The use of image-guided systems (IGS) for brain biopsy has increased in neurosurgical practice. We sought to evaluate the accuracy of a plastic, disposable burr hole mounted guide for stereotactic biopsy using an IGS and compare the results of different targeting methods with those of frame based localization. METHODS MRIs were performed on a skull model with mounted fiducials with a stereotactic frame in place and data was loaded onto the Stealth IGS. The model was placed in a Mayfield head holder and fixed to the OR table. Registration of imaging to physical space was carried out. Using three different targeting methods on the Stealth IGS, the distance between the target and the predicted position of the target, the offset error, was measured in three dimensions and confirmed by 2 observers. A sum of squares for the 3 offset errors in all planes was used to calculate the summed vector error. The same MRI dataset used with the Cosman-Roberts-Wells (CRW) stereotactic frame for comparison. The summed vector error was calculated in the same manner to compare the accuracy of targeting with these guides to the frame-based CRW system. RESULTS For frameless stereotaxy using the "Straight- guide 4 2D" targeting method the mean error was 2.58 +/- 0.51 mm (n=12). The vector error was 5.23 +/- 0.54 (n=4). For the registration set and target using the "Offset- guide 4 2D" targeting method the mean error was 1.66 +/- 0.36 mm (n=12). The vector error was 3.32 +/- 0.72 (n=4). The best localization was obtained with the "probe's eye" planning and targeting. The mean error was 0.33 +/- 0.16 mm (n=12). The vector error was 1.0 +/- 0.28 (n=4). We found a statistical difference between the different techniques (P<0.001) (Kruskal-Wallis One Way Analysis of Variance on Ranks). An all pairwise multiple comparison procedure (Holm-Sidak method) found an overall significance level = 0.05. For the frame-based CRW the mean error from the target was 1.03 +/- 0.19 mm (n=18) and the mean target localization error vector was 2.23 +/- 0.14 (n=6). We found a statistically significant difference between NDT guide "Probes Eye" vs. the MR-CRW (P=0.003, Mann-Whitney Rank Sum Test). CONCLUSIONS These results indicate that using MR imaging, surgical planning software and the skull mounted Navigus-DT with the probe's eye view option for targeting, localization accuracy appears to fall within acceptable ranges compared with frame-based methods which have been the standards for stereotactic brain biopsy and functional neurosurgery. Furthermore, there may be considerable differences in accuracy between different targeting methods.
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Affiliation(s)
- Alfredo Quiñones-Hinojosa
- Department of Neurological Surgery, Brain Tumor Research Center, University of California at San Francisco, San Francisco, CA, USA.
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Smith JS, Quiñones-Hinojosa A, Barbaro NM, McDermott MW. Frame-based stereotactic biopsy remains an important diagnostic tool with distinct advantages over frameless stereotactic biopsy. J Neurooncol 2005; 73:173-9. [PMID: 15981109 DOI: 10.1007/s11060-004-4208-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECT As the availability of image-guided surgical navigation systems has increased, the application of frame-based biopsy has declined at our institution, despite equivalent accuracy and safety. There are several cost issues separating the use of surgical navigation systems and stereotactic frames for simple biopsy which may have implications in this era of health care cost control. We retrospectively reviewed the UCSF experience with stereotactic brain biopsy from a 9 year period. METHODS Data were collected for 213 consecutive stereotactic brain biopsies performed at UCSF (139 frame-based and 74 frameless). There were no significant differences between the frame-based and frameless biopsy groups with regard to patient demographics, overall histopathology, proportion of nondiagnostic biopsies, or incidence of complications. General anesthesia was used for 9 (6%) and 70 (95%) of the frame-based and frameless biopsy cases, respectively. Frame-based biopsies required a mean of 114+/-3 min of operating room time, while frameless biopsies required 185+/-6 min (P<0.0001). For patients admitted to our neurosurgery service who underwent frame-based (n=110) or frameless (n=52) biopsy within 24 h of admission, the mean lengths of hospital stay were 1.8+/-0.2 and 3.2+/-0.6 days, respectively (P=0.007). CONCLUSION Frame-based and frameless stereotactic biopsy approaches were equally effective at providing a tissue diagnosis with minimum morbidity and mortality. The frame-based approach, however, required significantly less anesthesia resources, less operating room time and shorter hospital stays, and thus should still be considered a first-line approach for stereotactic brain biopsy.
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Affiliation(s)
- Justin S Smith
- Department of Neurological Surgery, Brain Tumor Research Center, University of California at San Francisco, 505 Parnassus Avenue, 94143-0112 San Francisco, California, USA.
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