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Cooke DL, Levitt MR, Kim LJ, Hallam DK, Sekhar LN, Ghodke BV. Laser-assisted flat-detector CT-guided intracranial access. Int J Comput Assist Radiol Surg 2015; 11:467-72. [PMID: 26239371 DOI: 10.1007/s11548-015-1271-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/20/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Flat-detector CT can be integrated with C-arm fluoroscopy for CT-guided neurosurgical and endovascular procedures. We studied the accuracy of this technique with laser assistance in targeting intracranial lesions in a cranial model. METHODS An acrylic scale-model skull containing foam parenchyma was embedded with 2.16-mm-diameter targets. A flat-detector CT was acquired and registered to the skull's position. Ten targets were accessed with biopsy needles under fluoroscopic guidance, flat-detector CT overlay, and laser assistance. Accuracy was measured from the needle tip to the target center using flat-detector CT. RESULTS Ten targets were accessed successfully using XperGuide software. Needles were placed within 1.30 [Formula: see text] 0.63 mm of target isocenter. Accuracy did not vary by entry site, operator, location, or lesion depth. CONCLUSIONS Laser-assisted flat-detector CT-guided targeting of all intracranial targets was successful with excellent accuracy. This technique can be applied to other minimally invasive neurosurgical procedures.
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Affiliation(s)
- Daniel L Cooke
- Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Michael R Levitt
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104-2499, USA. .,Department of Radiology, University of Washington, Seattle, WA, USA.
| | - Louis J Kim
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104-2499, USA.,Department of Radiology, University of Washington, Seattle, WA, USA
| | - Danial K Hallam
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104-2499, USA.,Department of Radiology, University of Washington, Seattle, WA, USA
| | - Laligam N Sekhar
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104-2499, USA
| | - Basavaraj V Ghodke
- Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104-2499, USA.,Department of Radiology, University of Washington, Seattle, WA, USA
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Mabray MC, Datta S, Lillaney PV, Moore T, Gehrisch S, Talbott JF, Levitt MR, Ghodke BV, Larson PS, Cooke DL. Accuracy of flat panel detector CT with integrated navigational software with and without MR fusion for single-pass needle placement. J Neurointerv Surg 2015; 8:731-5. [PMID: 26047903 DOI: 10.1136/neurintsurg-2015-011799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 05/21/2015] [Indexed: 11/04/2022]
Abstract
PURPOSE Fluoroscopic systems in modern interventional suites have the ability to perform flat panel detector CT (FDCT) with navigational guidance. Fusion with MR allows navigational guidance towards FDCT occult targets. We aim to evaluate the accuracy of this system using single-pass needle placement in a deep brain stimulation (DBS) phantom. MATERIALS AND METHODS MR was performed on a head phantom with DBS lead targets. The head phantom was placed into fixation and FDCT was performed. FDCT and MR datasets were automatically fused using the integrated guidance system (iGuide, Siemens). A DBS target was selected on the MR dataset. A 10 cm, 19 G needle was advanced by hand in a single pass using laser crosshair guidance. Radial error was visually assessed against measurement markers on the target and by a second FDCT. Ten needles were placed using CT-MR fusion and 10 needles were placed without MR fusion, with targeting based solely on FDCT and fusion steps repeated for every pass. RESULTS Mean radial error was 2.75±1.39 mm as defined by visual assessment to the centre of the DBS target and 2.80±1.43 mm as defined by FDCT to the centre of the selected target point. There were no statistically significant differences in error between MR fusion and non-MR guided series. CONCLUSIONS Single pass needle placement in a DBS phantom using FDCT guidance is associated with a radial error of approximately 2.5-3.0 mm at a depth of approximately 80 mm. This system could accurately target sub-centimetre intracranial lesions defined on MR.
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Affiliation(s)
- Marc C Mabray
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | | | - Prasheel V Lillaney
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Teri Moore
- Siemens Healthcare AG, Forchheim, Germany
| | | | - Jason F Talbott
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Basavaraj V Ghodke
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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