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Khan RI, Golahmadi AK, Killeen RP, O' Brien DF, Murphy C. Image-guided navigation in posterior orbital tumour surgery: a comparative cohort study. Orbit 2024:1-10. [PMID: 38687963 DOI: 10.1080/01676830.2024.2343299] [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: 01/05/2024] [Accepted: 04/09/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE The posterior orbit is a confined space, harbouring neurovascular structures, frequently distorted by tumours. Image-guided navigation (IGN) has the potential to allow accurate localisation of these lesions and structures, reducing collateral damage whilst achieving surgical objectives. METHODS We assessed the feasibility, effectiveness and safety of using an electromagnetic IGN for posterior orbital tumour surgery via a comparative cohort study. Outcomes from cases performed with IGN were compared with a retrospective cohort of similar cases performed without IGN, presenting a descriptive and statistical comparative analysis. RESULTS Both groups were similar in mean age, gender and tumour characteristics. IGN set-up and registration were consistently achieved without significant workflow disruption. In the IGN group, fewer lateral orbitotomies (6.7% IGN, 46% non-IGN), and more transcutaneous lid and transconjunctival incisions (93% IGN, 53% non-IGN) were performed (p = .009). The surgical objective was achieved in 100% of IGN cases, with no need for revision surgery (vs 23% revision surgery in non-IGN, p = .005). There was no statistically significant difference in surgical complications. CONCLUSION The use of IGN was feasible and integrated into the orbital surgery workflow to achieve surgical objectives more consistently and allowed the use of minimal access approaches. Future multicentre comparative studies are needed to explore the potential of this technology further.
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Affiliation(s)
- Rizwana I Khan
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- School of Medicine, Royal College of Surgeons Ireland University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Ronan P Killeen
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Donncha F O' Brien
- School of Medicine, Royal College of Surgeons Ireland University of Medicine and Health Sciences, Dublin, Ireland
- Department of Neurosurgery, National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland
| | - Conor Murphy
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
- School of Medicine, Royal College of Surgeons Ireland University of Medicine and Health Sciences, Dublin, Ireland
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Pivazyan G, Sandhu FA, Beaufort AR, Cunningham BW. Basis for error in stereotactic and computer-assisted surgery in neurosurgical applications: literature review. Neurosurg Rev 2022; 46:20. [PMID: 36536143 DOI: 10.1007/s10143-022-01928-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Technological advancements in optoelectronic motion capture systems have allowed for the development of high-precision computer-assisted surgery (CAS) used in cranial and spinal surgical procedures. Errors generated sequentially throughout the chain of components of CAS may have cumulative effect on the accuracy of implant and instrumentation placement - potentially affecting patient outcomes. Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of CAS. Error reporting measures vary between studies. Understanding error generation, mechanisms of propagation, and how they relate to workflow can assist clinicians in error mitigation and improve accuracy during navigation in neurosurgical procedures. Diligence in planning, fiducial positioning, system registration, and intra-operative workflow have the potential to improve accuracy and decrease disparity between planned and final instrumentation and implant position. This study reviews the potential errors associated with each step in computer-assisted surgery and provides a basis for disparity in intrinsic accuracy versus achieved accuracy in the clinical operative environment.
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Affiliation(s)
- Gnel Pivazyan
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA.
| | - Faheem A Sandhu
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | | | - Bryan W Cunningham
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Efficacy and safety of the endoscopic "wet-field" technique for removal of supratentorial cavernous malformations. Acta Neurochir (Wien) 2022; 164:2587-2594. [PMID: 35732840 DOI: 10.1007/s00701-022-05273-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/11/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Cerebral cavernous malformations (CMs) presenting with focal neurological symptoms or mass effects require surgical removal. In recent years, cylindrical retractors have been widely utilized for the removal of deep-seated lesions during both microscopic and endoscopic surgery. In the present study, we evaluated the efficacy and safety of endoscopic transcylinder removal of CMs using a novel wet-field technique. METHODS We included 13 patients with supratentorial CMs who had undergone endoscopic transcylinder surgery between April 2013 and March 2022. One patient experienced recurrence of the CM and underwent a second endoscopic transcylinder surgery. Therefore, we retrospectively evaluated 14 procedures. The surgical field was continuously irrigated with artificial cerebrospinal fluid to maintain expansion and visualization of the tumor bed. We termed this method as the "wet-field technique." Patient characteristics, symptoms, and pre- and postoperative magnetic resonance imaging results were obtained from medical records. RESULTS The average maximum CM diameter was 35.3 mm (range: 10-65 mm). Cylinder diameters were 6 mm in eight procedures, 10 mm in four procedures, and 17 mm in one procedure. Wet-field technique was applied in all cases. The endoscope provided a bright field of view even under water. Continuous water irrigation made it easier to observe the entire tumor bed which naturally expanded by water pressure. Gross total resection was achieved in 13 procedures, while subtotal resection was achieved in one procedure. No surgical complications were observed. CONCLUSIONS The endoscopic transcylinder removal using wet-field technique is safe and effective for the removal of symptomatic intracranial supratentorial CMs.
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Wang Z, Su X, Yu Y, Wang Z, Li K, Gao Y, Tian Y, Du C. A review of literature and meta-analysis of one-puncture success rate in radiofrequency thermocoagulation with different guidance techniques for trigeminal neuralgia. Eur J Med Res 2022; 27:141. [PMID: 35933404 PMCID: PMC9356501 DOI: 10.1186/s40001-022-00758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Radiofrequency thermocoagulation (RFT) is a type of Gasserian ganglion-level ablative intervention that is used for the treatment of trigeminal neuralgia. Guidance technologies are used to assist in the cannulation of the foramen ovale (FO) or foramen rotundum (FR) target. We conducted a systematic review to assess the value of different guidance technologies for RFT. METHODS We searched PubMed, Embase, the Cochrane database, Web of Science, and PROSPERO for studies published from January 2005 until December 2020. Randomized or nonrandomized comparative studies and nonrandomized studies without internal controls were included. The Cochrane Risk of Bias Tool and the nonrandomized studies of interventions-I tool were used to assess individual study characteristics and overall quality. RESULTS Our query identified 765 publications, and we were able to analyze 11 studies on patients suffering from trigeminal neuralgia. Only one study involved randomized controlled trials, whereas the others featured nonrandomized designs, predominantly before-and-after comparisons. Most of them were observational studies. A total of 222 participants were included, with a median number (range) of 20 (3-53) participants. The objective response rate (ORR) of the one-puncture success rate of RFT using puncture guidance for trigeminal neuralgia was 92% [95% CI (0.79-1), P < 0.001]. Statistically significant differences were observed in the cannulation and operation times between the guided and manual puncture groups (P < 0.001). CONCLUSIONS RFT with puncture guidance technology has an absolute advantage in puncturing the foramen ovale or foramen rotundum.
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Affiliation(s)
- Zhengming Wang
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China
| | - Xu Su
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China
| | - Yin Yu
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China
| | - Zhijun Wang
- Department of Pediatric Surgery, The First Hospital of Jilin University, Changchun, China
| | - Kai Li
- Department of Anesthesia, The Third Hospital of Jilin University & China-Japan Union Hospital, Changchun, China
| | - Yufei Gao
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China
| | - Yu Tian
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China.
| | - Chao Du
- Department of Neurosurgery, The Third Hospital of Jilin University & China-Japan Union Hospital, No. 126, Xiantai Street, Changchun, 130033, China.
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Minchev G, Wurzer A, Ptacek W, Kronreif G, Micko A, Dorfer C, Wolfsberger S. Development of a miniaturized robotic guidance device for stereotactic neurosurgery. J Neurosurg 2022; 137:479-488. [PMID: 34920429 DOI: 10.3171/2021.9.jns21794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Consistently high accuracy and a straightforward use of stereotactic guidance systems are crucial for precise stereotactic targeting and a short procedural duration. Although robotic guidance systems are widely used, currently available systems do not fully meet the requirements for a stereotactic guidance system that combines the advantages of frameless surgery and robotic technology. The authors developed and optimized a small-scale yet highly accurate guidance system that can be seamlessly integrated into an existing operating room (OR) setup due to its design. The aim of this clinical study is to outline the development of this miniature robotic guidance system and present the authors' clinical experience. METHODS After extensive preclinical testing of the robotic stereotactic guidance system, adaptations were implemented for robot fixation, software usability, navigation integration, and end-effector application. Development of the robotic system was then advanced in a clinical series of 150 patients between 2013 and 2019, including 111 needle biopsies, 13 catheter placements, and 26 stereoelectroencephalography (SEEG) electrode placements. During the clinical trial, constant modifications were implemented to meet the setup requirements, technical specifications, and workflow for each indication. For each application, specific setup, workflow, and median procedural accuracy were evaluated. RESULTS Application of the miniature robotic system was feasible in 149 of 150 cases. The setup in each procedure was successfully implemented without adding significant OR time. The workflow was seamlessly integrated into the preexisting procedure. In the course of the study, procedural accuracy was improved. For the biopsy procedure, the real target error (RTE) was reduced from a mean of 1.8 ± 1.03 mm to 1.6 ± 0.82 mm at entry (p = 0.05), and from 1.7 ± 1.12 mm to 1.6 ± 0.72 mm at target (p = 0.04). For the SEEG procedures, the RTE was reduced from a mean of 1.43 ± 0.78 mm in the first half of the procedures to 1.12 ± 0.52 mm (p = 0.002) at entry in the second half, and from 1.82 ± 1.13 mm to 1.57 ± 0.98 mm (p = 0.069) at target, respectively. No healing complications or infections were observed in any case. CONCLUSIONS The miniature robotic guidance device was able to prove its versatility and seamless integration into preexisting workflow by successful application in 149 stereotactic procedures. According to these data, the robot could significantly improve accuracy without adding time expenditure.
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Affiliation(s)
- Georgi Minchev
- 1Department of Neurosurgery, Medical University Vienna; and
| | - Ayguel Wurzer
- 1Department of Neurosurgery, Medical University Vienna; and
| | - Wolfgang Ptacek
- 2Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
| | - Gernot Kronreif
- 2Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria
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Su Y, Sun Y, Hosny M, Gao W, Fu Y. Facial landmark-guided surface matching for image-to-patient registration with an RGB-D camera. Int J Med Robot 2022; 18:e2373. [PMID: 35133715 DOI: 10.1002/rcs.2373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/17/2022] [Accepted: 01/29/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Fiducial marker-based image-to-patient registration is the most common way in image-guided neurosurgery, which is labour-intensive, time consuming, invasive and error prone. METHODS We proposed a method of facial landmark-guided surface matching for image-to-patient registration using an RGB-D camera. Five facial landmarks are localised from preoperative magnetic resonance (MR) images using deep learning and RGB image using Adaboost with multi-scale block local binary patterns, respectively. The registration of two facial surface point clouds derived from MR images and RGB-D data is initialised by aligning these five landmarks and further refined by weighted iterative closest point algorithm. RESULTS Phantom experiment results show the target registration error is less than 3 mm when the distance from the camera to the phantom is less than 1000 mm. The registration takes less than 10 s. CONCLUSIONS The proposed method is comparable to the state-of-the-arts in terms of the accuracy yet more time-saving and non-invasive.
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Affiliation(s)
- Yixian Su
- State Key Laboratory of Robotics and System, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Yu Sun
- State Key Laboratory of Robotics and System, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Mohamed Hosny
- State Key Laboratory of Robotics and System, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China.,Department of Electrical Engineering, Benha Faculty of Engineering, Benha University, Benha, Egypt
| | - Wenpeng Gao
- State Key Laboratory of Robotics and System, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Yili Fu
- State Key Laboratory of Robotics and System, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
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Cunningham BW, Brooks DM. Comparative Analysis of Optoelectronic Accuracy in the Laboratory Setting Versus Clinical Operative Environment: A Systematic Review. Global Spine J 2022; 12:59S-74S. [PMID: 35393881 PMCID: PMC8998481 DOI: 10.1177/21925682211035083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The optoelectronic camera source and data interpolation process serve as the foundation for navigational integrity in robotic-assisted surgical platforms. The current systematic review serves to provide a basis for the numerical disparity observed when comparing the intrinsic accuracy of optoelectronic cameras versus accuracy in the laboratory setting and clinical operative environments. METHODS Review of the PubMed and Cochrane Library research databases was performed. The exhaustive literature compilation obtained was then vetted to reduce redundancies and categorized into topics of intrinsic accuracy, registration accuracy, musculoskeletal kinematic platforms, and clinical operative platforms. RESULTS A total of 465 references were vetted and 137 comprise the basis for the current analysis. Regardless of application, the common denominators affecting overall optoelectronic accuracy are intrinsic accuracy, registration accuracy, and application accuracy. Intrinsic accuracy equaled or was less than 0.1 mm translation and 0.1 degrees rotation per fiducial. Controlled laboratory platforms reported 0.1 to 0.5 mm translation and 0.1 to 1.0 degrees rotation per array. Accuracy in robotic-assisted spinal surgery reported 1.5 to 6.0 mm translation and 1.5 to 5.0 degrees rotation when comparing planned to final implant position. CONCLUSIONS Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of robotic-assisted spinal surgery. Transitioning from controlled laboratory to clinical operative environments requires an increased number of steps in the optoelectronic kinematic chain and error potential. Diligence in planning, fiducial positioning, system registration and intra-operative workflow have the potential to improve accuracy and decrease disparity between planned and final implant position.
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Affiliation(s)
- Bryan W. Cunningham
- Department of Orthopaedic Surgery, Musculoskeletal Research and Innovation Institute, MedStar Union Memorial Hospital, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Daina M. Brooks
- Department of Orthopaedic Surgery, Musculoskeletal Research and Innovation Institute, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Frameless robot-assisted stereotactic biopsies for lesions of the brainstem-a series of 103 consecutive biopsies. J Neurooncol 2022; 157:109-119. [PMID: 35083580 DOI: 10.1007/s11060-022-03952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE Targeted treatment for brainstem lesions requires above all a precise histopathological and molecular diagnosis. In the current technological era, robot-assisted stereotactic biopsies represent an accurate and safe procedure for tissue diagnosis. We present our center's experience in frameless robot-assisted biopsies for brainstem lesions. METHODS We performed a retrospective analysis of all patients benefitting from a frameless robot-guided stereotactic biopsy at our University Hospital, from 2001 to 2017. Patients consented to the use of data and/or images. The NeuroMate® robot (Renishaw™, UK) was used. We report on lesion location, trajectory strategy, histopathological diagnosis and procedure safety. RESULTS Our series encompasses 96 patients (103 biopsies) treated during a 17 years period. Mean age at biopsy: 34.0 years (range 1-78). Most common location: pons (62.1%). Transcerebellar approach: 61 procedures (59.2%). Most common diagnoses: diffuse glioma (67.0%), metastases (7.8%) and lymphoma (6.8%). Non conclusive diagnosis: 10 cases (9.7%). After second biopsy this decreased to 4 cases (4.1%). Overall biopsy diagnostic yield: 95.8%. Permanent disability was recorded in 3 patients (2.9%, all adults), while transient complications in 17 patients (17.7%). Four cases of intra-tumoral hematoma were recorded (one case with rapid decline and fatal issue). Adjuvant targeted treatment was performed in 72.9% of patients. Mean follow-up (in the Neurosurgery Department): 2.2 years. CONCLUSION Frameless robot-assisted stereotactic biopsies can provide the initial platform towards a safe and accurate management for brainstem lesions, offering a high diagnostic yield with low permanent morbidity.
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Factors affecting diagnostic yield in stereotactic biopsy for brain lesions: a 5-year single-center series. Neurosurg Rev 2021; 45:1473-1480. [PMID: 34628562 DOI: 10.1007/s10143-021-01671-6] [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: 06/24/2021] [Revised: 07/31/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
The objective of this study is to determine the factors that are associated with the diagnostic yield of stereotactic brain biopsy. A retrospective analysis was performed on 50 consecutive patients who underwent stereotactic brain biopsies in a single institute from 2014 to 2019. Variables including age, gender, lesion topography and characteristics, biopsy methods, and surgeon's experience were analyzed along with diagnostic rate. This study included 31 male and 19 female patients with a mean age of 48.4 (range: 1-76). Of these, 25 underwent frameless brain-suite stereotactic biopsies, 15 were frameless Portable Brain-lab® stereotactic biopsies and 10 were frame-based CRW® stereotactic biopsies. There was no statistical difference between the diagnostic yield of the three methods. The diagnostic yield in our series was 76%. Age, gender, and biopsy methods had no impact on diagnostic yield. Periventricular and pineal lesion biopsies were significantly associated with negative diagnostic yield (p = 0.01) whereas larger lesions were significantly associated with a positive yield (p = 0.01) with the mean volume of lesions in the positive yield group (13.6 cc) being higher than the negative yield group (7 cc). The diagnostic yields seen between senior and junior neurosurgeons in the biopsy procedure were 95% and 63%, respectively (p = 0.02). Anatomical location of the lesion, volume of the lesion, and experience of the surgeon have significant impacts on the diagnostic yield in stereotactic brain biopsy. There was no statistical difference between the diagnostic yield of the three methods, age, gender, and depth of lesion.
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Skyrman S, Lai M, Edström E, Burström G, Förander P, Homan R, Kor F, Holthuizen R, Hendriks BHW, Persson O, Elmi-Terander A. Augmented reality navigation for cranial biopsy and external ventricular drain insertion. Neurosurg Focus 2021; 51:E7. [PMID: 34333469 DOI: 10.3171/2021.5.focus20813] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the accuracy (deviation from the target or intended path) and efficacy (insertion time) of an augmented reality surgical navigation (ARSN) system for insertion of biopsy needles and external ventricular drains (EVDs), two common neurosurgical procedures that require high precision. METHODS The hybrid operating room-based ARSN system, comprising a robotic C-arm with intraoperative cone-beam CT (CBCT) and integrated video tracking of the patient and instruments using nonobtrusive adhesive optical markers, was used. A 3D-printed skull phantom with a realistic gelatinous brain model containing air-filled ventricles and 2-mm spherical biopsy targets was obtained. After initial CBCT acquisition for target registration and planning, ARSN was used for 30 cranial biopsies and 10 EVD insertions. Needle positions were verified by CBCT. RESULTS The mean accuracy of the biopsy needle insertions (n = 30) was 0.8 mm ± 0.43 mm. The median path length was 39 mm (range 16-104 mm) and did not correlate to accuracy (p = 0.15). The median device insertion time was 149 seconds (range 87-233 seconds). The mean accuracy for the EVD insertions (n = 10) was 2.9 mm ± 0.8 mm at the tip with a 0.7° ± 0.5° angular deviation compared with the planned path, and the median insertion time was 188 seconds (range 135-400 seconds). CONCLUSIONS This study demonstrated that ARSN can be used for navigation of percutaneous cranial biopsies and EVDs with high accuracy and efficacy.
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Affiliation(s)
- Simon Skyrman
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marco Lai
- 2Philips Research, High Tech Campus 34, Eindhoven.,3Eindhoven University of Technology (TU/e), Eindhoven
| | - Erik Edström
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Burström
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Petter Förander
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Flip Kor
- 5Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Benno H W Hendriks
- 2Philips Research, High Tech Campus 34, Eindhoven.,5Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Oscar Persson
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- 1Department of Neurosurgery, Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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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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Lovin BD, Yu J, Choi JS, Patel AJ, Giannoni CM, Gallagher KK. Outcomes in Pediatric Transsphenoidal Pituitary Surgery Stratified by the Use of Image Guidance: An Analysis of the Kids' Inpatient Database from 1997 to 2016. J Neurol Surg B Skull Base 2020; 82:e45-e50. [PMID: 34306916 DOI: 10.1055/s-0040-1701602] [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: 06/21/2019] [Accepted: 12/24/2019] [Indexed: 10/24/2022] Open
Abstract
Background To evaluate the utilization of image guidance technology for pediatric transsphenoidal pituitary resection (TSPR) and analyze the complication rates, length of stay (LOS), and total cost for such surgeries as function of time and utilization of image guidance. Methods The Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) was queried for all cases of TSPR between 1997 and 2016. Factors extracted included patient demographics, use of image guidance, LOS, total cost, and complications, including panhypopituitarism, diabetes insipidus (DI), cerebrospinal fluid (CSF) rhinorrhea, and cranial nerve (CN) III, IV, and VI palsies. Multivariate logistic regression was utilized to determine the odds ratio of developing panhypopituitarism, DI, CSF rhinorrhea, and CN palsies for image-guided versus nonimage-guided cases. A generalized linear model was used to determine the effect of image guidance on inflation-adjusted total cost and LOS. Results A total of 1,297 cases of TSPR were included in the KID over this time period. The majority were female, Caucasian, and older than 15 years. Utilization of image guidance has rapidly increased since 2006. Complication rates were comparable, but when controlling for other factors, the use of image guidance showed a lower risk of postoperative DI ( p = 0.05). The use of image guidance also resulted in a shorter LOS by 2.84 days ( p < 0.001) with no associated increase in total cost ( p = 0.663). Conclusion The use of imaging guidance for pediatric TSPR has precipitously increased in recent years, as it is cost-effective, decreases LOS, and may lead to lower complication rates, such as DI.
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Affiliation(s)
- Benjamin D Lovin
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Justin Yu
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Jonathan S Choi
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Akash J Patel
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States.,Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Carla M Giannoni
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - K Kelly Gallagher
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
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13
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Satoh M, Nakajima T, Yamaguchi T, Watanabe E, Kawai K. Application of Augmented Reality to Stereotactic Biopsy. Neurol Med Chir (Tokyo) 2019; 59:444-447. [PMID: 31548442 PMCID: PMC6867933 DOI: 10.2176/nmc.tn.2019-0128] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Both frame-based stereotaxy and frameless stereotaxy are established surgical procedures. However, they each have their respective disadvantages when used in the biopsy of a deep-seated lesion. To overcome the drawbacks associated with these procedures, we evaluated the feasibility of applying augmented reality (AR) to stereotactic biopsy. We applied our trans-visible navigator (TVN) to frame-based stereotactic biopsy in five cases of deep-seated lesions. This navigation system uses the AR concept, allowing surgeons to view three-dimensional virtual models of anatomical structures superimposed over the surgical field on a tablet personal computer. Using TVN, we could easily confirm a clear trajectory avoiding the important structures as well as the target point’s location in the lesion. Use of the stereotactic apparatus allowed the surgeon to easily advance the biopsy probe to the target point. Consequently, a satisfactory histopathological diagnosis without complication was achieved in all cases. In conclusion, applying AR to stereotactic biopsy is feasible and may improve the safety of the procedure.
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Affiliation(s)
- Makoto Satoh
- Department of Neurosurgery, Jichi Medical University
| | | | | | - Eiju Watanabe
- Department of Neurosurgery, Jichi Medical University
| | - Kensuke Kawai
- Department of Neurosurgery, Jichi Medical University
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14
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Mongen MA, Willems PWA. Current accuracy of surface matching compared to adhesive markers in patient-to-image registration. Acta Neurochir (Wien) 2019; 161:865-870. [PMID: 30879130 PMCID: PMC6483968 DOI: 10.1007/s00701-019-03867-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/03/2019] [Indexed: 11/28/2022]
Abstract
Object In the past, the accuracy of surface matching has been shown to be disappointing. We aimed to determine whether this had improved over the years by assessing application accuracy of current navigation systems, using either surface matching or point-pair matching. Methods Eleven patients, scheduled for intracranial surgery, were included in this study after a power analysis had shown this small number to be sufficient. Prior to surgery, one additional fiducial marker was placed on the scalp, the “target marker,” where the entry point of surgery was to be expected. Using one of three different navigation systems, two patient-to-image registration procedures were performed: one based on surface matching and one based on point-pair matching. Each registration procedure was followed by the digitization of the target marker’s location, allowing calculation of the target registration error. If the system offered surface matching improvement, this was always used; and for the two systems that routinely offer an estimate of neuronavigation accuracy, this was also recorded. Results The error in localizing the target marker using point-pair matching or surface matching was respectively 2.49 mm and 5.35 mm, on average (p < 0.001). In those four cases where an attempt was made to improve the surface matching, the error increased to 6.35 mm, on average. For the seven cases where the system estimated accuracy, this estimate did not correlate with target registration error (R2 = 0.04, p = 0.67). Conclusion The accuracy of navigation systems has not improved over the last decade, with surface matching consistently yielding errors that are twice as large as when point-pair matching with adhesive markers is used. These errors are not reliably reflected by the systems own prediction, when offered. These results are important to make an informed choice between image-to-patient registration strategies, depending on the type of surgery at hand.
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Affiliation(s)
- Mireli A Mongen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter W A Willems
- Departmesnt of Neurosurgery, University Medical Center Utrecht, Internal Postage G03.124, PO-box 85500, 3584 CX, Utrecht, The Netherlands.
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15
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Stereotactic brain biopsy: evaluation of robot-assisted procedure in 60 patients. Acta Neurochir (Wien) 2019; 161:545-552. [PMID: 30675655 DOI: 10.1007/s00701-019-03808-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Frameless stereotactic biopsies, particularly robot-assisted procedures are increasing in neurosurgery centers. Results of these procedures should be at least equal to or greater than frame-based reference procedure. Evaluate robot-assisted technology is necessary in particular, when a team has chosen to switch from one to another method. OBJECTIVE The objective of our prospective work was (i) to evaluate the success rate of contributive robotic-assisted biopsy in 60 patients, to report the morbidity and mortality associated with the procedure and (ii) to compare it with literature data. METHODS We performed a prospective and descriptive study including 60 consecutive patients having had robotic-assisted stereotactic biopsy at the Rouen University Hospital, France. All patients had presurgical imaging before the procedure included Magnetic Resonance Imaging merged with Computed Tomography scan acquisition. Registration was mostly performed with a touch-free laser (57/60). A control Computed Tomography scan was always realized at day 0 or day 1 after surgery. Data collected were success rate, bleeding, clinical worsening, infection, and mortality. RESULTS All the biopsies were considered as contributive and lead to the final diagnosis. In 41/60 patients (68%), the lesion was glial. Six in 60 patients (10%) had visible bleeding without clinical worsening related, 5/60 patients (8.5%) showed clinical impairment following surgery, which was permanent in 2 patients, and 1/60 patient presented generalized seizures. We did not report any infection and mortality. CONCLUSION Robot-assisted frameless surgery is efficient and provides a reasonable alternative to frame-based procedure. The operating time can be reduced, without increasing morbidity and mortality rates.
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Legnani FG, Franzini A, Mattei L, Saladino A, Casali C, Prada F, Perin A, Cojazzi V, Saini M, Kronreif G, Wolfsberger S, DiMeco F. Image-Guided Biopsy of Intracranial Lesions with a Small Robotic Device (iSYS1): A Prospective, Exploratory Pilot Study. Oper Neurosurg (Hagerstown) 2019; 17:403-412. [DOI: 10.1093/ons/opy411] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 01/04/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Robotic technologies have been used in the neurosurgical operating rooms for the last 30 yr. They have been adopted for several stereotactic applications and, particularly, image-guided biopsy of intracranial lesions which are not amenable for open surgical resection.
OBJECTIVE
To assess feasibility, safety, accuracy, and diagnostic yield of robot-assisted frameless stereotactic brain biopsy with a recently introduced miniaturized device (iSYS1; Interventional Systems Medizintechnik GmbH, Kitzbühel, Austria), fixed to the Mayfield headholder by a jointed arm.
METHODS
Clinical and surgical data of all patients undergoing frameless stereotactic biopsies using the iSYS1 robotized system from October 2016 to December 2017 have been prospectively collected and analyzed. Facial surface registration has been adopted for optical neuronavigation.
RESULTS
Thirty-nine patients were included in the study. Neither mortality nor morbidity related to the surgical procedure performed with the robot was recorded. Diagnostic tissue samples were obtained in 38 out of 39 procedures (diagnostic yield per procedure was 97.4%). All patients received a definitive histological diagnosis. Mean target error was 1.06 mm (median 1 mm, range 0.1-4 mm).
CONCLUSION
The frameless robotic iSYS1-assisted biopsy technique was determined to be feasible, safe, and accurate procedure; moreover, the diagnostic yield was high. The surface matching registration method with computed tomography as the reference image set did not negatively affect the accuracy of the procedure.
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Affiliation(s)
- Federico G Legnani
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy
| | - Luca Mattei
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy
| | - Andrea Saladino
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy
| | - Cecilia Casali
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy
| | - Francesco Prada
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy
- Department of Neurological Surgery, University of Virginia Health Science Center, Charlottesville, Virginia
| | - Alessandro Perin
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy
| | - Vittoria Cojazzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy
| | - Marco Saini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy
| | - Gernot Kronreif
- Austrian Center for Medical Innovation and Technology, ACMIT Gmbh, Wiener Neustadt, Austria
| | - Stefan Wolfsberger
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Università degli Studi, Milan, Italy
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Ekşi MŞ. A New Era in Stereotactic Brain Biopsy: Frameless Navigation-Based System. J Neurosci Rural Pract 2019; 10:3. [PMID: 30765960 PMCID: PMC6337985 DOI: 10.4103/jnrp.jnrp_281_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Murat Şakir Ekşi
- Department of Neurosurgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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18
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Bernstock JD, Wright Z, Bag AK, Gessler F, Gillespie GY, Markert JM, Friedman GK, Johnston JM. Stereotactic Placement of Intratumoral Catheters for Continuous Infusion Delivery of Herpes Simplex Virus -1 G207 in Pediatric Malignant Supratentorial Brain Tumors. World Neurosurg 2018; 122:e1592-e1598. [PMID: 30481622 DOI: 10.1016/j.wneu.2018.11.122] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/13/2018] [Accepted: 11/15/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVE The engineered herpes simplex virus-1 G207, is a promising therapeutic option for central nervous system tumors. The first-ever pediatric phase 1 trial of continuous-infusion delivery of G207 via intratumoral catheters for recurrent or progressive malignant brain tumors is ongoing. In this article, we describe surgical techniques for the accurate placement of catheters in multiple supratentorial locations and perioperative complications associated with such procedures. METHODS A prospective study of G207 in children with recurrent malignant supratentorial tumors is ongoing. Preoperative stereotactic protocol magnetic resonance imaging was performed, and catheter trajectories planned using StealthStation planning software. Children underwent placement of 3-4 silastic catheters using a small incision burr hole and the Vertek system. Patients had a preinfusion computed tomography scan to confirm correct placement of catheters. RESULTS Six children underwent implantation of 3-4 catheters. Locations of catheter placement included frontal, temporal, parietal, and occipital lobes, and the insula and thalamus. There were no clinically significant perioperative complications. Postoperative computed tomography scans coupled with preoperative MRI scans demonstrated accurate placement of 21 of 22 catheters, with 1 misplaced catheter pulled back to an optimal location at the bedside. One patient had hemorrhage along the catheter tract that was clinically asymptomatic. Another patient had cerebrospinal fluid leak from a biopsy incision 9 days after surgery that was oversewn without complication. CONCLUSIONS The placement of multiple intratumoral catheters in pediatric patients with supratentorial tumors via frameless stereotactic techniques is feasible and safe. Intratumoral catheters provide a potentially effective route for the delivery of G207 and may be employed in other trials utilizing oncolytic virotherapy for brain tumors.
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Affiliation(s)
- Joshua D Bernstock
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Zachary Wright
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Asim K Bag
- Department of Radiology, Neuroradiology Section, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Florian Gessler
- Department of Neurosurgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | | | - James M Markert
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gregory K Friedman
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA; Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - James M Johnston
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abel TJ, Varela Osorio R, Amorim-Leite R, Mathieu F, Kahane P, Minotti L, Hoffmann D, Chabardes S. Frameless robot-assisted stereoelectroencephalography in children: technical aspects and comparison with Talairach frame technique. J Neurosurg Pediatr 2018; 22:37-46. [PMID: 29676681 DOI: 10.3171/2018.1.peds17435] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Robot-assisted stereoelectroencephalography (SEEG) is gaining popularity as a technique for localization of the epileptogenic zone (EZ) in children with pharmacoresistant epilepsy. Here, the authors describe their frameless robot-assisted SEEG technique and report preliminary outcomes and relative complications in children as compared to results with the Talairach frame-based SEEG technique. METHODS The authors retrospectively analyzed the results of 19 robot-assisted SEEG electrode implantations in 17 consecutive children (age < 17 years) with pharmacoresistant epilepsy, and compared these results to 19 preceding SEEG electrode implantations in 18 children who underwent the traditional Talairach frame-based SEEG electrode implantation. The primary end points were seizure-freedom rates, operating time, and complication rates. RESULTS Seventeen children (age < 17 years) underwent a total of 19 robot-assisted SEEG electrode implantations. In total, 265 electrodes were implanted. Twelve children went on to have EZ resection: 4 demonstrated Engel class I outcomes, whereas 2 had Engel class II outcomes, and 6 had Engel class III-IV outcomes. Of the 5 patients who did not have resection, 2 underwent thermocoagulation. One child reported transient paresthesia associated with 2 small subdural hematomas, and 3 other children had minor asymptomatic intracranial hemorrhages. There were no differences in complication rates, rates of resective epilepsy surgery, or seizure freedom rates between this cohort and the preceding 18 children who underwent Talairach frame-based SEEG. The frameless robot-assisted technique was associated with shorter operating time (p < 0.05). CONCLUSIONS Frameless robot-assisted SEEG is a safe and effective means of identifying the EZ in children with pharmacoresistant partial epilepsy. Robot-assisted SEEG is faster than the Talairach frame-based method, and has equivalent safety and efficacy. The former, furthermore, facilitates more electrode trajectory possibilities, which may improve the localization of epileptic networks.
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Affiliation(s)
- Taylor J Abel
- 1Clinique de Neurochirurgie, and.,2Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Ricardo Amorim-Leite
- 3Clinique Neurologique, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; and
| | - Francois Mathieu
- 2Division of Neurosurgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Philippe Kahane
- 3Clinique Neurologique, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; and
| | - Lorella Minotti
- 3Clinique Neurologique, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France; and
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Dockx R, Peremans K, Duprat R, Vlerick L, Van Laeken N, Saunders JH, Polis I, De Vos F, Baeken C. Accurate external localization of the left frontal cortex in dogs by using pointer based frameless neuronavigation. PeerJ 2017; 5:e3425. [PMID: 28713649 PMCID: PMC5507169 DOI: 10.7717/peerj.3425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/16/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In humans, non-stereotactic frameless neuronavigation systems are used as a topographical tool for non-invasive brain stimulation methods such as Transcranial Magnetic Stimulation (TMS). TMS studies in dogs may provide treatment modalities for several neuropsychological disorders in dogs. Nevertheless, an accurate non-invasive localization of a stimulation target has not yet been performed in this species. HYPOTHESIS This study was primarily put forward to externally locate the left frontal cortex in 18 healthy dogs by means of a human non-stereotactic neuronavigation system. Secondly, the accuracy of the external localization was assessed. ANIMALS A total of 18 healthy dogs, drawn at random from the research colony present at the faculty of Veterinary Medicine (Ghent University), were used. METHODS Two sets of coordinates (X, Y, Z and X″, Y″, Z″) were compared on each dog their tomographical dataset. RESULTS The non-stereotactic neuronavigation system was able to externally locate the frontal cortex in dogs with accuracy comparable with human studies. CONCLUSION AND CLINICAL IMPORTANCE This result indicates that a non-stereotactic neuronavigation system can accurately externally locate the left frontal cortex and paves the way to use guided non-invasive brain stimulation methods as an alternative treatment procedure for neurological and behavioral disorders in dogs. This technique could, in analogy with human guided non-invasive brain stimulation, provide a better treatment outcome for dogs suffering from anxiety disorders when compared to its non-guided alternative.
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Affiliation(s)
- Robrecht Dockx
- Department of Psychiatry and Medical Psychology, Ghent University, Ghent, East-Flanders, Belgium.,Faculty of Veterinary Medicine, Ghent University, Merelbeke, East-Flanders, Belgium
| | - Kathelijne Peremans
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, East-Flanders, Belgium
| | - Romain Duprat
- Department of Psychiatry and Medical Psychology, Ghent University, Ghent, East-Flanders, Belgium
| | - Lise Vlerick
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, East-Flanders, Belgium
| | - Nick Van Laeken
- Faculty of Pharmaceutical Sciences, Ghent University, Ghent, East-Flanders, Belgium
| | - Jimmy H Saunders
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, East-Flanders, Belgium
| | - Ingeborgh Polis
- Faculty of Veterinary Medicine, Ghent University, Merelbeke, East-Flanders, Belgium
| | - Filip De Vos
- Faculty of Pharmaceutical Sciences, Ghent University, Ghent, East-Flanders, Belgium
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Ghent University, Ghent, East-Flanders, Belgium
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De Benedictis A, Trezza A, Carai A, Genovese E, Procaccini E, Messina R, Randi F, Cossu S, Esposito G, Palma P, Amante P, Rizzi M, Marras CE. Robot-assisted procedures in pediatric neurosurgery. Neurosurg Focus 2017; 42:E7. [DOI: 10.3171/2017.2.focus16579] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDuring the last 3 decades, robotic technology has rapidly spread across several surgical fields due to the continuous evolution of its versatility, stability, dexterity, and haptic properties. Neurosurgery pioneered the development of robotics, with the aim of improving the quality of several procedures requiring a high degree of accuracy and safety. Moreover, robot-guided approaches are of special interest in pediatric patients, who often have altered anatomy and challenging relationships between the diseased and eloquent structures. Nevertheless, the use of robots has been rarely reported in children. In this work, the authors describe their experience using the ROSA device (Robotized Stereotactic Assistant) in the neurosurgical management of a pediatric population.METHODSBetween 2011 and 2016, 116 children underwent ROSA-assisted procedures for a variety of diseases (epilepsy, brain tumors, intra- or extraventricular and tumor cysts, obstructive hydrocephalus, and movement and behavioral disorders). Each patient received accurate preoperative planning of optimal trajectories, intraoperative frameless registration, surgical treatment using specific instruments held by the robotic arm, and postoperative CT or MR imaging.RESULTSThe authors performed 128 consecutive surgeries, including implantation of 386 electrodes for stereo-electroencephalography (36 procedures), neuroendoscopy (42 procedures), stereotactic biopsy (26 procedures), pallidotomy (12 procedures), shunt placement (6 procedures), deep brain stimulation procedures (3 procedures), and stereotactic cyst aspiration (3 procedures). For each procedure, the authors analyzed and discussed accuracy, timing, and complications.CONCLUSIONSTo the best their knowledge, the authors present the largest reported series of pediatric neurosurgical cases assisted by robotic support. The ROSA system provided improved safety and feasibility of minimally invasive approaches, thus optimizing the surgical result, while minimizing postoperative morbidity.
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Affiliation(s)
| | - Andrea Trezza
- 1Department of Neuroscience and Neurosurgical Unit and
- 2Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, University of Milano-Bicocca, San Gerardo Hospital, Monza
| | - Andrea Carai
- 1Department of Neuroscience and Neurosurgical Unit and
| | - Elisabetta Genovese
- 3Enterprise Risk Management, Medical Physics Department, Bambino Gesù Children’s Hospital, IRCCS, Rome
| | | | | | - Franco Randi
- 1Department of Neuroscience and Neurosurgical Unit and
| | - Silvia Cossu
- 1Department of Neuroscience and Neurosurgical Unit and
| | | | - Paolo Palma
- 1Department of Neuroscience and Neurosurgical Unit and
| | | | - Michele Rizzi
- 4“Claudio Munari” Center for Epilepsy Surgery, Niguarda Hospital, Milan; and
- 5Department of Neuroscience, University of Parma, Italy
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Bradac O, Steklacova A, Nebrenska K, Vrana J, de Lacy P, Benes V. Accuracy of VarioGuide Frameless Stereotactic System Against Frame-Based Stereotaxy: Prospective, Randomized, Single-Center Study. World Neurosurg 2017; 104:831-840. [PMID: 28454992 DOI: 10.1016/j.wneu.2017.04.104] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Frameless stereotactic brain biopsy systems are widely used today. VarioGuide (VG) is a relatively novel frameless system. Its accuracy was studied in a laboratory setting but has not yet been studied in the clinical setting. The purpose of this study was to determine its accuracy and diagnostic yield and to compare this with frame-based (FB) stereotaxy. MATERIAL AND METHODS Overall, 53 patients (33 males and 20 females, 60 ± 15 years old) were enrolled into this prospective, randomized, single-center study. Twenty-six patients were randomized into the FB group and 27 patients into the VG group. Real trajectory was pointed on intraoperative magnetic resonance. The distance of the targets and angle deviation between the planned and real trajectories were computed. The overall discomfort of the patient was subjectively assessed by the visual analog scale score. RESULTS The median lesion volume was 5 mL (interquartile range [IQR]: 2-16 mL) (FB) and 16 mL (IQR: 2-27 mL) (VG), P = 0.133. The mean distance of the targets was 2.7 ± 1.1 mm (FB) and 2.9 ± 1.3 mm (VG), P = 0.456. Mean angle deviation was 2.6 ± 1.3 deg (FB) and 3.5 ± 2.1 deg (VG), P = 0.074. Diagnostic yield was 93% (25/27) in VG and 96% (25/26) in FB, P = 1.000. Mean operating time was 47 ± 26 minutes (FB) and 59 ± 31 minutes (VG), P = 0.140. One minor bleeding was encountered in the VG group. Overall patient discomfort was significantly higher in the FB group (visual analog scale score 2.5 ± 2.1 vs. 1.2 ± 0.6, P = 0,004). CONCLUSIONS The VG system proved to be comparable in terms of the trajectory accuracy, rate of complications and diagnostic yield compared with the "gold standard" represented by the traditional FB stereotaxy for patients undergoing brain biopsy. VG is also better accepted by patients.
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Affiliation(s)
- Ondrej Bradac
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic.
| | - Anna Steklacova
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic
| | - Katerina Nebrenska
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic
| | - Jiri Vrana
- Department of Neuroradiology, Military University Hospital, Prague, The Czech Republic
| | - Patricia de Lacy
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Vladimir Benes
- Department of Neurosurgery and Neurooncology, Military University Hospital and First Medical Faculty, Charles University, Prague, The Czech Republic
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Wani AA, Wani MA, Ramzan AU, Nizami FA, Malik NK, Shafiq S, Ahmad R, Kumar A, Lone I, Makhdoomi R. Combination of needle aspiration and core needle biopsy: A new technique of stereotactic biopsy. Asian J Neurosurg 2016; 11:94-7. [PMID: 27057212 PMCID: PMC4802960 DOI: 10.4103/1793-5482.145188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The study aims at describing the results of using a new technique to acquire the tissue sample in stereotactic biopsy of brain lesions. Materials and Methods: The study was performed in 19 patients over a period of 5 years in which we used the new technique, i.e., Abrar and Afzal technique (AT) of obtaining tissue biopsy. It is a combination of core tissue biopsy and needle aspiration techniques. The technique was devised to acquire greater amount of tissue for pathologic study. Results: While we could give pathologic diagnosis in 18 patients out of 19 (94.7%), in one patient, the tissue sample revealed only inflammatory cells and definitive diagnosis could not be reached. There was no significant morbidity or any mortality in the series. Conclusion: Abrar and Afzal technique is a reasonably accurate technique of acquiring larger tissue sample in stereotactic brain biopsy without any additional risks. It can be done with little modification of the conventional equipment available with the stereotactic system.
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Affiliation(s)
- Abrar Ahad Wani
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - M Afzal Wani
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf U Ramzan
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Furqan A Nizami
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Nayil K Malik
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - S Shafiq
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rais Ahmad
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Ashish Kumar
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Iqbal Lone
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rumana Makhdoomi
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Scranton RA, Fung SH, Britz GW. Transulcal parafascicular minimally invasive approach to deep and subcortical cavernomas: technical note. J Neurosurg 2016; 125:1360-1366. [PMID: 26943846 DOI: 10.3171/2015.12.jns152185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cavernomas comprise 8%-15% of intracranial vascular lesions, usually supratentorial in location and superficial. Cavernomas in the thalamus or subcortical white matter represent a unique challenge for surgeons in trying to identify and then use a safe corridor to access and resect the pathology. Previous authors have described specific open microsurgical corridors based on pathology location, often with technical difficulty and morbidity. This series presents 2 cavernomas that were resected using a minimally invasive approach that is less technically demanding and has a good safety profile. The authors report 2 cases of cavernoma: one in the thalamus and brainstem with multiple hemorrhages and the other in eloquent subcortical white matter. These lesions were resected through a transulcal parafascicular approach with a port-based minimally invasive technique. In this series there was complete resection with no neurological complications. The transulcal parafascicular minimally invasive approach relies on image interpretation and trajectory planning, intraoperative navigation, cortical cannulation and subcortical space access, high-quality optics, and resection as key elements to minimize exposure and retraction and maximize tissue preservation. The authors applied this technique to 2 patients with cavernomas in eloquent locations with excellent outcomes.
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Affiliation(s)
| | - Steve H Fung
- Radiology, Houston Methodist Neurological Institute, Houston, Texas
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Verburg N, Baayen JC, Idema S, Klitsie MAJ, Claus S, de Jonge CS, Vandertop WP, de Witt Hamer PC. In Vivo Accuracy of a Frameless Stereotactic Drilling Technique for Diagnostic Biopsies and Stereoelectroencephalography Depth Electrodes. World Neurosurg 2015; 87:392-8. [PMID: 26700749 DOI: 10.1016/j.wneu.2015.11.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accurate frameless neuronavigation is highly important in cranial neurosurgery. The accuracy demonstrated in phantom models might not be representative for results in patients. Few studies describe the in vivo quantitative accuracy of neuronavigation in patients. The use of a frameless stereotactic drilling technique for stereoelectroencephalography depth electrode implantation in epilepsy patients, as well as diagnostic biopsies, provides a unique opportunity to assess the accuracy with postoperative imaging of preoperatively planned trajectories. METHODS In 7 patients with refractory epilepsy, 89 depth electrodes were implanted using a frameless stereotactic drilling technique. Each electrode was planned on a preoperative magnetic resonance and computed tomographic scan, and verified on postoperative computed tomographic scan. After fusion of preoperative and postoperative imaging, the accuracy for each electrode was calculated as the Euclidean distance between the planned and observed position of the electrode tip. RESULTS The median Euclidean distance between planned and observed electrode implantations was 3.5 mm (95% confidence interval, 2.9-3.9 mm) with a range of 1.2-13.7 mm. CONCLUSIONS In this study, we showed that the in vivo accuracy of our frameless stereotactic drilling technique, suitable for stereoelectroencephalography depth electrode placement and diagnostic brain biopsies, was 3.5 mm.
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Affiliation(s)
- Niels Verburg
- Neurosurgical Center Amsterdam, VU Medical Centre, Amsterdam, The Netherlands.
| | - Johannes C Baayen
- Neurosurgical Center Amsterdam, VU Medical Centre, Amsterdam, The Netherlands
| | - Sander Idema
- Neurosurgical Center Amsterdam, VU Medical Centre, Amsterdam, The Netherlands
| | - Michiel A J Klitsie
- Neurosurgical Center Amsterdam, VU Medical Centre, Amsterdam, The Netherlands
| | - Steven Claus
- Department of Clinical Neurophysiology, Stichting Epilepsy Instellingen Nederland, Epilepsy Institutes in The Netherlands, SEIN, Heemstede, The Netherlands
| | | | - W Peter Vandertop
- Neurosurgical Center Amsterdam, VU Medical Centre, Amsterdam, The Netherlands
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Dolati P, Gokoglu A, Eichberg D, Zamani A, Golby A, Al-Mefty O. Multimodal navigated skull base tumor resection using image-based vascular and cranial nerve segmentation: A prospective pilot study. Surg Neurol Int 2015; 6:172. [PMID: 26674155 PMCID: PMC4665134 DOI: 10.4103/2152-7806.170023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/31/2015] [Indexed: 12/03/2022] Open
Abstract
Background: Skull base tumors frequently encase or invade adjacent normal neurovascular structures. For this reason, optimal tumor resection with incomplete knowledge of patient anatomy remains a challenge. Methods: To determine the accuracy and utility of image-based preoperative segmentation in skull base tumor resections, we performed a prospective study. Ten patients with skull base tumors underwent preoperative 3T magnetic resonance imaging, which included thin section three-dimensional (3D) space T2, 3D time of flight, and magnetization-prepared rapid acquisition gradient echo sequences. Imaging sequences were loaded in the neuronavigation system for segmentation and preoperative planning. Five different neurovascular landmarks were identified in each case and measured for accuracy using the neuronavigation system. Each segmented neurovascular element was validated by manual placement of the navigation probe, and errors of localization were measured. Results: Strong correspondence between image-based segmentation and microscopic view was found at the surface of the tumor and tumor-normal brain interfaces in all cases. The accuracy of the measurements was 0.45 ± 0.21 mm (mean ± standard deviation). This information reassured the surgeon and prevented vascular injury intraoperatively. Preoperative segmentation of the related cranial nerves was possible in 80% of cases and helped the surgeon localize involved cranial nerves in all cases. Conclusion: Image-based preoperative vascular and neural element segmentation with 3D reconstruction is highly informative preoperatively and could increase the vigilance of neurosurgeons for preventing neurovascular injury during skull base surgeries. Additionally, the accuracy found in this study is superior to previously reported measurements. This novel preliminary study is encouraging for future validation with larger numbers of patients.
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Affiliation(s)
- Parviz Dolati
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Abdulkerim Gokoglu
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Daniel Eichberg
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amir Zamani
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alexandra Golby
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Dorfer C, Stefanits H, Pataraia E, Wolfsberger S, Feucht M, Baumgartner C, Czech T. Frameless stereotactic drilling for placement of depth electrodes in refractory epilepsy: operative technique and initial experience. Neurosurgery 2015; 10 Suppl 4:582-90; discussion 590-1. [PMID: 25050581 DOI: 10.1227/neu.0000000000000509] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND For stereotactic implantation of depth electrodes in refractory epilepsy, both frame-based and frameless techniques have been developed. The higher versatility of current frameless techniques compared with framed-based methods is paid by the need of a standard burr hole for the implantation of 1 electrode. OBJECTIVE To develop a frameless method that allows convenient implantation of the electrode via a percutaneous bolt as used in frame-based methods, thereby avoiding the need for a standard burr hole. METHODS We adopted our technique from frameless stereotactic biopsy and designed the GIDE, a bone-fixated Guide for Implantation of Depth Electrodes. This reducing sleeve works as a stabilizer of the neuronavigation arm through bony contact and allows percutaneous stereotactic drilling, screwing of an implantation bolt, and placement of the depth electrode. RESULTS Twenty-six electrodes in 7 patients (5 male and 2 female patients; median age, 19.6 years; range, 5.5-39.1 years) were successfully implanted. The overall accuracy was comparable to that of frameless stereotactic biopsy with a target deviation of 3.0±1.9 mm (mean±SD). All electrodes were within or touched the targeted anatomic structure with an adequate quality of the recordings. We encountered no hemorrhage or neurological deficit related to the depth electrode. CONCLUSION Our technique combines the high versatility of frameless stereotaxy with the convenient implantation and fixation of the depth electrode via a percutaneous bolt used in frame-based stereotactic methods. Thus, our technique allows fast, efficient implantation of depth electrodes for intracranial electroencephalography recordings.
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Affiliation(s)
- Christian Dorfer
- *Departments of Neurosurgery, ‡Pediatrics and Adolescence Medicine, and §Neurology, Medical University of Vienna, Vienna, Austria; ¶2nd Neurological Department, General Hospital Hietzing, Vienna, Austria
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Grimm F, Naros G, Gutenberg A, Keric N, Giese A, Gharabaghi A. Blurring the boundaries between frame-based and frameless stereotaxy: feasibility study for brain biopsies performed with the use of a head-mounted robot. J Neurosurg 2015; 123:737-42. [PMID: 26067616 DOI: 10.3171/2014.12.jns141781] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Frame-based stereotactic interventions are considered the gold standard for brain biopsies, but they have limitations with regard to flexibility and patient comfort because of the bulky head ring attached to the patient. Frameless image guidance systems that use scalp fiducial markers offer more flexibility and patient comfort but provide less stability and accuracy during drilling and biopsy needle positioning. Head-mounted robot-guided biopsies could provide the advantages of these 2 techniques without the downsides. The goal of this study was to evaluate the feasibility and safety of a robotic guidance device, affixed to the patient's skull through a small mounting platform, for use in brain biopsy procedures. METHODS This was a retrospective study of 37 consecutive patients who presented with supratentorial lesions and underwent brain biopsy procedures in which a surgical guidance robot was used to determine clinical outcomes and technical procedural operability. RESULTS The portable head-mounted device was well tolerated by the patients and enabled stable drilling and needle positioning during surgery. Flexible adjustments of predefined paths and selection of new trajectories were successfully performed intraoperatively without the need for manual settings and fixations. The patients experienced no permanent deficits or infections after surgery. CONCLUSIONS The head-mounted robot-guided approach presented here combines the stability of a bone-mounted set-up with the flexibility and tolerability of frameless systems. By reducing human interference (i.e., manual parameter settings, calibrations, and adjustments), this technology might be particularly useful in neurosurgical interventions that necessitate multiple trajectories.
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Affiliation(s)
- Florian Grimm
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Tuebingen; and
| | - Georgios Naros
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Tuebingen; and
| | - Angelika Gutenberg
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Naureen Keric
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Alf Giese
- Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, Eberhard Karls University, Tuebingen; and
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Chung TK, Riley KO, Woodworth BA. The use of image-guidance during transsphenoidal pituitary surgery in the United States. Am J Rhinol Allergy 2015; 29:215-20. [PMID: 25975254 PMCID: PMC5554330 DOI: 10.2500/ajra.2015.29.4166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Intraoperative image guidance is a useful modality for transsphenoidal pituitary surgery. However, the outcomes associated with this technology have not been systematically evaluated. OBJECTIVE The purpose of the study was to quantify complication rates with and without the use of image guidance during transsphenoidal pituitary surgery using a nationwide database with broadly applicable results. METHODS A retrospective analysis of the Nationwide Inpatient Sample was performed from 2007 to 2011. Transsphenoidal pituitary resections for adenomas were identified by International Classification of Diseases-9th Revision, Clinical Modification code. The effect of image guidance on cerebrospinal fluid (CSF) leak complications and cost-benefit was analyzed. RESULTS A total of 48,848 transsphenoidal pituitary resections were identified, of which 77.5% were partial resections and 22.5% were complete. Pathologic indications included benign (89.3%), malignant primary (0.6%), and malignant secondary (0.4%). Complications included same-stay death (0.4%), CSF leak (8.8%), postoperative CSF rhinorrhea (1.9%), diabetes insipidus (12.4%), and meningitis (0.4%). Image guidance was employed in 7% (n = 3401) of all cases. When analyzed by modality, computed tomography (CT)-assisted procedures had lower CSF rhinorrhea rates (1.1%) compared with cases with no image guidance (1.9%), whereas magnetic resonance (MR)-assisted procedures had the highest rates (2.7%, χ2 p < 0.001). Rates of CSF leak demonstrated a similar pattern (CT 6.4%, no image guidance 8.9%, MR 9.2%, χ2 p < 0.001). CT-assisted surgery had significantly shorter length of stay (2.9 days) versus no image guidance (3.7 days, p < 0.001), lower total charges ($47,589 versus $62,629, p < 0.001), and lower total cost ($16,748 versus $20,530, p < 0.001). CONCLUSIONS CT-assisted surgery is associated with a lower rate of CSF leak, shorter length of stay, and lower cost compared with patients without image guidance. Further studies that control for severity and extent of disease are warranted to confirm this finding.
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Affiliation(s)
- Thomas K. Chung
- From the Departments of Surgery/Division of Otolaryngology and
| | - Kristen O. Riley
- Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
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Ommaya reservoir with ventricular catheter placement for chemotherapy with frameless and pinless electromagnetic surgical neuronavigation. Clin Neurol Neurosurg 2015; 130:61-6. [DOI: 10.1016/j.clineuro.2014.12.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/23/2014] [Accepted: 12/29/2014] [Indexed: 11/19/2022]
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Frame-based stereotactic neurosurgery in children under the age of seven: Freiburg University's experience from 99 consecutive cases. Clin Neurol Neurosurg 2014; 130:42-7. [PMID: 25576884 DOI: 10.1016/j.clineuro.2014.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/02/2014] [Accepted: 12/20/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Stereotactic frame-based procedures proved to be precise, safe and are of widespread use among adult patients. Regarding pediatric patients few data is available, therefore the use of the stereotactic frame remains controversial in this population. This motivated us to report our experience in stereotactic procedures in the youngest patients and review the literature concerning this subject. METHODS All frame-based procedures performed in patients younger than seven years in the University of Freiburg during the last 10 years were retrospectively analyzed and discussed under the light of the current literature. RESULTS The studied population was composed of 72 patients under the age of seven (mean 3.4±2.1 years-old), in whom 99 stereotactic procedures were performed. Brain tumor was present in 60 patients, hydrocephalus in five, cystic lesions in three, intracranial abscess in three and epilepsy in one patient. Stereotactic surgery was performed in 36 cases for brachytherapy, in 29 for biopsy, in 20 cases for cyst puncture, in eight for stereotactically guided endoscopic ventriculostomy, in five for catheter placement and in one case for depth electrode insertion. The overall complication rate was 5%. There were three cases of pin penetration through the skull, one case of frame dislocation after extensive cyst drainage and two skull fractures. Neurologic deficit related to frame fixation was observed in none of the cases. In disagreement with other authors, no case of pin related infection, air embolism, hematoma or CSF leak was observed. CONCLUSION Frame-based stereotactic neurosurgery is a safe technique also in the youngest patients. Rather than the simple use of torque-limiting devices training and experience in the manual adjustment of the stereotactic frame in children have been proven to be crucial factors that contribute to reducing pin related complications.
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Staudacher A, Oevermann A, Stoffel MH, Gorgas D. Validation of a magnetic resonance imaging guided stereotactic access to the ovine brainstem. BMC Vet Res 2014; 10:216. [PMID: 25241810 PMCID: PMC4177427 DOI: 10.1186/s12917-014-0216-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 09/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Anatomical differences between humans and domestic mammals preclude the use of reported stereotactic approaches to the brainstem in animals. In animals, brainstem biopsies are required both for histopathological diagnosis of neurological disorders and for research purposes. Sheep are used as a translational model for various types of brain disease and therefore a species-specific approach needs to be developed. The aim of the present study was to establish a minimally invasive, accurate and reproducible stereotactic approach to the brainstem of sheep, using the magnetic resonance imaging guided BrainsightTM frameless stereotactic system. Results A transoccipital transcerebellar approach with an entry point in the occipital bone above the vermis between the transverse sinus and the external occipital protuberance was chosen. This approach provided access to the target site in all heads. The overall mean needle placement error was 1.85 ± 1.22 mm. Conclusions The developed transoccipital transcerebellar route is short, provides accurate access to the ovine caudal cranial fossa and is a promising approach to be further assessed in live animals.
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Affiliation(s)
| | | | | | - Daniela Gorgas
- Division of Clinical Radiology, Department of Clinical Veterinary Medicine, Vetsuisse-Faculty, University of Berne, Längassstrasse 128, Berne, CH 3012, Switzerland.
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Wallner J, Reinbacher KE, Pau M, Feichtinger M. Intermuscular pterygoid-temporal abscess following inferior alveolar nerve block anesthesia-A computer tomography based navigated surgical intervention: Case report and review. Ann Maxillofac Surg 2014; 4:110-4. [PMID: 24987612 PMCID: PMC4073452 DOI: 10.4103/2231-0746.133090] [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] [Indexed: 11/12/2022] Open
Abstract
Inferior alveolar nerve block (IANB) anesthesia is a common local anesthetic procedure. Although IANB anesthesia is known for its safety, complications can still occur. Today immediately or delayed occurring disorders following IANB anesthesia and their treatment are well-recognized. We present a case of a patient who developed a symptomatic abscess in the pterygoid region as a result of several inferior alveolar nerve injections. Clinical symptoms included diffuse pain, reduced mouth opening and jaw's hypomobility and were persistent under a first step conservative treatment. Since image-based navigated interventions have gained in importance and are used for various procedures a navigated surgical intervention was initiated as a second step therapy. Thus precise, atraumatic surgical intervention was performed by an optical tracking system in a difficult anatomical region. A symptomatic abscess was treated by a computed tomography-based navigated surgical intervention at our department. Advantages and disadvantages of this treatment strategy are evaluated.
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Affiliation(s)
- Jürgen Wallner
- Department of Maxillofacial Surgery, Medical University of Graz, Graz, Austria
| | | | - Mauro Pau
- Department of Maxillofacial Surgery, Medical University of Graz, Graz, Austria
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Weise LM, Eibach S, Setzer M, Seifert V, Herrmann E, Hattingen E. Accuracy of 3D fluoroscopy in cranial stereotactic surgery: a comparative study in phantoms and patients. Acta Neurochir (Wien) 2014; 156:581-8. [PMID: 24142196 DOI: 10.1007/s00701-013-1897-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND To assess the precision and accuracy of 3D fluoroscopy (XT) in phantoms and patients compared to computed tomography (CT) in localizing stereotactic probes. METHODS Approval was obtained from the institutional research ethics board. The prospective phantom study was compared to a retrospective patient cohort. Accuracy was assessed by the mean error and precision by the mean dispersion between XT and CT with a cubic or a skull phantom containing metallic spheres installed on plates or along trajectories. Significance was assessed by Friedman's and Levene's test. Secondary endpoints were Euclidean error, other influences e.g. installed frame and radiation exposure. RESULTS A total of 3,342 distances were assessed in 17 XT and 13 CT phantom scans. The cubic phantom showed mean distance errors of 0.33 mm (SD + -0.46 mm) for XT compared to 0.19 mm (SD + -0.83 mm) for CT scans (p = 0.0004) and a dispersion of 0.22 mm (XT) and 0.70 mm (CT). The dispersion was 0.36 mm with and 0.63 mm without a stereotactic frame (p < 0.0001). The mean Euclidean error was 0.72 mm (SD + -0.59 mm) in the skull phantom and 1.34 mm (SD + -0.82 mm) in the patient cohort. The effective dose was 0.65 mSv for the XT and 1.12 mSv for the CT. CONCLUSIONS The accuracy of XT imaging in phantoms revealed a slightly lower accuracy but higher precision than the CT. The overall accuracy of XT was higher than that of the stereotactic frame allowing stereotactic localization with about half of the effective dose of a CT-scan.
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Duffau H. Intraoperative cortico–subcortical stimulations in surgery of low-grade gliomas. Expert Rev Neurother 2014; 5:473-85. [PMID: 16026231 DOI: 10.1586/14737175.5.4.473] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In order to increase the impact of surgery on the natural history of low-grade glioma, resection should be of maximum importance. Nevertheless, since low-grade gliomas are frequently located in eloquent structures, function needs to be preserved. Therefore, studying the functional organization of the brain is mandatory for each patient due to the inter-individual anatomofunctional variability, increased in tumors due to cerebral plasticity. This strategy enables performance of a resection according to functional boundaries. However, preoperative neurofunctional imaging only allows the study of the gray matter. Consequently, since low-grade glioma invades cortical and subcortical structures and shows an infiltrative progression along the fibers, the goal of this review is to focus on the techniques able to map both cortical and subcortical regions. In addition to diffusion tensor imaging, which gives only anatomical information and still needs to be validated, intraoperative direct cortico-subcortical electrostimulation is the sole current method allowing a reliable study of the individual anatomofunctional connectivity, concerning sensorimotor, language and other cognitive functions. Its actual contribution is detailed, both in clinical issues, especially the improvement of the benefit/risk ratio of low-grade glioma resection, and in fundamental applications--namely, a new door to the connectionism and cerebral plasticity.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, INSERM U678, UPMC, Hôpital Salpêtrière, 47-83 Bd de l'hôpital, 75013, Paris, France.
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Lefranc M, Capel C, Pruvot AS, Fichten A, Desenclos C, Toussaint P, Le Gars D, Peltier J. The Impact of the Reference Imaging Modality, Registration Method and Intraoperative Flat-Panel Computed Tomography on the Accuracy of the ROSA® Stereotactic Robot. Stereotact Funct Neurosurg 2014; 92:242-50. [DOI: 10.1159/000362936] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/13/2014] [Indexed: 11/19/2022]
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Güler Ö, Perwög M, Kral F, Schwarm F, Bárdosi ZR, Göbel G, Freysinger W. Quantitative error analysis for computer assisted navigation: a feasibility study. Med Phys 2013; 40:021910. [PMID: 23387758 DOI: 10.1118/1.4773871] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The benefit of computer-assisted navigation depends on the registration process, at which patient features are correlated to some preoperative imagery. The operator-induced uncertainty in localizing patient features-the user localization error (ULE)-is unknown and most likely dominating the application accuracy. This initial feasibility study aims at providing first data for ULE with a research navigation system. METHODS Active optical navigation was done in CT-images of a plastic skull, an anatomic specimen (both with implanted fiducials), and a volunteer with anatomical landmarks exclusively. Each object was registered ten times with 3, 5, 7, and 9 registration points. Measurements were taken at 10 (anatomic specimen and volunteer) and 11 targets (plastic skull). The active NDI Polaris system was used under ideal working conditions (tracking accuracy 0.23 mm root-mean-square, RMS; probe tip calibration was 0.18 mm RMS). Variances of tracking along the principal directions were measured as 0.18 mm(2), 0.32 mm(2), and 0.42 mm(2). ULE was calculated from predicted application accuracy with isotropic and anisotropic models and from experimental variances, respectively. RESULTS The ULE was determined from the variances as 0.45 mm (plastic skull), 0.60 mm (anatomic specimen), and 4.96 mm (volunteer). The predicted application accuracy did not yield consistent values for the ULE. CONCLUSIONS Quantitative data of application accuracy could be tested against prediction models with iso- and anisotropic noise models and revealed some discrepancies. This could potentially be due to the facts that navigation and one prediction model wrongly assume isotropic noise (tracking is anisotropic), while the anisotropic noise prediction model assumes an anisotropic registration strategy (registration is isotropic in typical navigation systems). The ULE data are presumably the first quantitative values for the precision of localizing anatomical landmarks and implanted fiducials. Submillimetric localization is possible for implanted screws; anatomic landmarks are not suitable for high-precision clinical navigation.
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Affiliation(s)
- Ö Güler
- Childrens' National Medical Center, Washington, DC 20010, USA
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Cardinale F, Cossu M, Castana L, Casaceli G, Schiariti MP, Miserocchi A, Fuschillo D, Moscato A, Caborni C, Arnulfo G, Lo Russo G. Stereoelectroencephalography: surgical methodology, safety, and stereotactic application accuracy in 500 procedures. Neurosurgery 2013; 72:353-66; discussion 366. [PMID: 23168681 DOI: 10.1227/neu.0b013e31827d1161] [Citation(s) in RCA: 379] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Stereoelectroencephalography (SEEG) methodology, originally developed by Talairach and Bancaud, is progressively gaining popularity for the presurgical invasive evaluation of drug-resistant epilepsies. OBJECTIVE To describe recent SEEG methodological implementations carried out in our center, to evaluate safety, and to analyze in vivo application accuracy in a consecutive series of 500 procedures with a total of 6496 implanted electrodes. METHODS Four hundred nineteen procedures were performed with the traditional 2-step surgical workflow, which was modified for the subsequent 81 procedures. The new workflow entailed acquisition of brain 3-dimensional angiography and magnetic resonance imaging in frameless and markerless conditions, advanced multimodal planning, and robot-assisted implantation. Quantitative analysis for in vivo entry point and target point localization error was performed on a sub--data set of 118 procedures (1567 electrodes). RESULTS The methodology allowed successful implantation in all cases. Major complication rate was 12 of 500 (2.4%), including 1 death for indirect morbidity. Median entry point localization error was 1.43 mm (interquartile range, 0.91-2.21 mm) with the traditional workflow and 0.78 mm (interquartile range, 0.49-1.08 mm) with the new one (P < 2.2 × 10). Median target point localization errors were 2.69 mm (interquartile range, 1.89-3.67 mm) and 1.77 mm (interquartile range, 1.25-2.51 mm; P < 2.2 × 10), respectively. CONCLUSION SEEG is a safe and accurate procedure for the invasive assessment of the epileptogenic zone. Traditional Talairach methodology, implemented by multimodal planning and robot-assisted surgery, allows direct electrical recording from superficial and deep-seated brain structures, providing essential information in the most complex cases of drug-resistant epilepsy.
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Affiliation(s)
- Francesco Cardinale
- Claudio Munari Centre for Epilepsy and Parkinson Surgery, Niguarda Ca' Granda Hospital, Milano, Italy.
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Tsermoulas G, Mukerji N, Borah AJ, Mitchell P, Ross N. Factors affecting diagnostic yield in needle biopsy for brain lesions. Br J Neurosurg 2012; 27:207-11. [PMID: 22984980 DOI: 10.3109/02688697.2012.722239] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We analyse the factors that are associated with the diagnostic yield of needle brain biopsy. MATERIAL AND METHODS We present a retrospective series of 124 consecutive biopsies in a 30-month period. Patients' demographics (age, gender), lesion topography (side, location, depth), lesion characteristics (histology, volume, radiological enhancement), type of biopsy procedure (freehand, ultrasound guided, frameless and frame-based stereotactic) and the use of intraoperative histologic examination were correlated with the diagnostic rate. Descriptive statistics and a nominal logistic regression model were used to evaluate the factors influencing diagnostic yield. RESULTS 63 men and 61 women were included in the study with mean age 59.2 (range: 16-86). 55 were frame-based stereotactic biopsies, 33 were frameless stereotactic biopsies, 29 biopsies were performed under ultrasound guidance and 7 freehand. The diagnostic yield in our series is 93.5%. The gender, lesion topography, biopsy method, use of intraoperative histology and enhancement did not correlate with the diagnostic yield. Younger age had a negative impact on diagnostic yield. 6 out of 8 inconclusive biopsies were in non-glial lesions (p < 0.05). The odds of obtaining a positive diagnosis increased sevenfold with every cc increase in lesion volume. CONCLUSION The age of the patient, the volume and the histology of the brain lesion had an impact on the diagnostic yield of needle biopsy. None of the other factors significantly influenced the diagnostic rate.
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Affiliation(s)
- Georgios Tsermoulas
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
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Gempt J, Buchmann N, Ryang YM, Krieg S, Kreutzer J, Meyer B, Ringel F. Frameless image-guided stereotaxy with real-time visual feedback for brain biopsy. Acta Neurochir (Wien) 2012; 154:1663-7. [PMID: 22847726 DOI: 10.1007/s00701-012-1425-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 06/08/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Frame-based stereotaxy remains the "gold standard" for cerebral biopsies and functional neurosurgery though new frameless stereotactic systems are evolving continually. As the technique of frameless stereotaxy gains increasing acceptance among neurosurgeons, this study assesses the feasibility of a system for frameless image-guided stereotaxy. METHODS All patients biopsied for intracranial lesions between February 2007 and August 2010 using the BrainLAB VarioGuide frameless stereotactic system were evaluated prospectively. Prior to surgery, patients underwent magnetic resonance (MR) imaging; additionally, fluoroethyl-tyrosine (FET)-positron emission tomography (PET) images were acquired and fused to MR images in selected cases. Biopsy trajectory length, lesion volume, procedure duration, and diagnostic yield were assessed. RESULTS Ninety-six diagnostic biopsies in 91 patients were evaluated. Lesion volume ranged from 0.17 to 121.8 cm(3); trajectory length from 25.3 to 101.9 mm. Diagnostic yield was 93.8%. Mean operation time from skin incision to wound closure was 42 min; in the operating room, it was 99 min. CONCLUSIONS Clinical experience indicates VarioGuide to be safe and accurate. Reachable range of lesion localisation appears to be comparable to a frame-based stereotaxy system. Operation times are brief. The unique design of this frameless stereotactic system allows real-time visual feedback of needle positioning.
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Affiliation(s)
- Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Germany
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Wang YY, Thiryayi WA, Ramaswamy R, Gnanalingham KK. Accuracy of Surgeon's Estimation of Sella Margins during Endoscopic Surgery for Pituitary Adenomas: Verification Using Neuronavigation. Skull Base 2012; 21:193-200. [PMID: 22451825 DOI: 10.1055/s-0031-1275635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We assessed the accuracy of a surgeon's localization of sella margins during endoscopic transsphenoidal surgery for pituitary adenomas, as verified using a neuronavigational system, and we identify types of pathology in which neuronavigation is of most benefit. We performed a prospective cohort study of 32 consecutive patients undergoing image-guided endoscopic transsphenoidal surgery for pituitary adenomas. We assessed the margin of error in the surgeon's localization of the superior and inferior margins of the sella and the lateral margins as determined by the medial border of left and right carotid arteries, using a magnetic resonance-based neuronavigational system. The overall mean error of localization of sella margins by the surgeon was 4.5 ± 3 mm. Localization of the inferior sella margin was more accurate (3.1 ± 2 mm mean error) compared with localization of the left (4.8 ± 3 mm) or right carotid arteries (4.6 ± 3 mm). Giant adenomas (> 2.5 cm), more invasive adenomas (Hardy grade IV), and those with parasellar extension (Hardy grades D and E) were associated with larger errors in localization of the carotid arteries. There was no significant difference when stratifying for recurrent surgery, nostril of approach, and sella morphology. During endoscopic transsphenoidal surgery, the margin of error in the surgeon's estimation of the sella margins for adenomas less than 2.5 cm located predominantly within the sella is relatively small. The margin of error increases for giant adenomas, with greater invasiveness and parasellar spread, and the use of neuronavigation can be especially useful in such cases.
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Affiliation(s)
- Yi Yuen Wang
- Department of Neurosurgery, Greater Manchester Neuroscience Centre, Salford Royal Foundation Trust Hospital, Greater Manchester, United Kingdom
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Tanaka S, Puffer RC, Hoover JM, Goerss SJ, Haugen LM, McGee K, Parney IF. Increased frameless stereotactic accuracy with high-field intraoperative magnetic resonance imaging. Neurosurgery 2012; 71:ons321-7; discussion ons327-8. [PMID: 22843131 DOI: 10.1227/neu.0b013e31826a88a9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Frameless stereotaxy commonly registers preoperative magnetic resonance imaging (MRI) to patients by using surface scalp anatomy or adhesive fiducial scalp markers. Patients' scalps may shift slightly between preoperative imaging and final surgical positioning with pinion placement, introducing error. This might be reduced when frameless stereotaxy is performed in a high-field intraoperative MRI (iMRI), as patients are positioned before imaging. This could potentially improve accuracy. OBJECTIVE To compare frameless stereotactic accuracy using a high-field iMRI with that using standard preoperative MRI. METHODS Data were obtained in 32 adult patients undergoing frameless stereotactic-guided brain tumor surgery. Stereotactic images were obtained with 1.5T MRI scanner either preoperatively (14 patients) or intraoperative (18 patients). System-generated accuracy measurements and distances from the actual center of each fiducial marker to that represented by neuronavigation were recorded. Finally, accuracy at multiple deep targets was assessed by using a life-sized human head stereotactic phantom in which fiducials were placed on deformable foam to mimic scalp. RESULTS : System-generated accuracy measurements were significantly better for the iMRI group (mean ± SEM = 1.04 ± 0.05 mm) than for the standard group (1.82 ± 0.09 mm; P < .001). Measured distances from the actual center of scalp fiducial markers to that represented by neuronavigation were also significantly smaller for iMRI (1.72 ± 0.10 mm) in comparison with the standard group (3.17 ± 0.22 mm; P < .001). Deep accuracy in the phantom model was significantly better with iMRI (1.67 ± 0.12 mm) than standard imaging (2.28 ± 0.14 mm; P = .003). CONCLUSION Frameless stereotactic accuracy is increased by using high-field iMRI compared with standard preoperative imaging.
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Affiliation(s)
- Shota Tanaka
- Department of Neurologic Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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Ayberk G, Yagli OE, Comert A, Esmer AF, Canturk N, Tekdemir I, Dinc H. Anatomic relationship between the anterior sylvian point and the pars triangularis. Clin Anat 2012; 25:429-36. [PMID: 22488994 DOI: 10.1002/ca.21264] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/27/2011] [Accepted: 07/29/2011] [Indexed: 11/10/2022]
Abstract
The aim of this study was to show morphological sulcal variations of the pars triangularis of the inferior frontal gyrus and to provide a clearer description of the anterior sylvian point. Thirty-six hemispheres of 18 adult cadavers were studied. The hemispheres were harvested by the classical autopsy method and fixed in 10% formalin solution for three weeks. In six hemispheres, the arteries and veins were filled with colored silicone. The proximal and distal segments of the sylvian fissure, the perpendicular distance of both the anterior sylvian point and inferior rolandic point to the insular cortex and the distances between the anterior ascending ramus and the precentral, central, and postcentral sulcus were measured. The anterior horizontal and ascending rami were exposed. The sulcus located on the pars triangularis was appraised. The relationship between the anterior sylvian point and the vascular structure around the sylvian fissure was examined. The rising of the anterior horizontal and ascending ramus from the sylvian fissure defines the shape of the pars triangularis. The pars triangularis has three shapes: V, U, and Y. In V- and Y-shaped pars triangularis both rami merge but in U-shaped pars triangularis the rami do not merge. The pars triangularis was Y-shaped in 30.76% (4/13) of the right hemispheres and in 50% (7/14) of the left hemispheres; U-shaped in 20.3% (3/13) of the right hemispheres and in 35.71% (5/14) of the left hemispheres; V-shaped in 40.61% (6/13) of the right hemispheres and in 14.29% (2/14) of the left hemispheres. Minimally invasive procedures use basic anatomic landmarks intracranially to reach the targeted area; therefore, exact and detailed knowledge of the anatomy of the sylvian fissure and pars triangularis is of great importance.
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Affiliation(s)
- Giyas Ayberk
- Second Department of Neurosurgery, Ataturk Training and Research Hospital, Bilkent/Ankara, Turkey.
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Bale R, Widmann G, Jaschke W. Stereotaxie und Robotik zur Ablation – Spielzeug oder Werkzeug? Radiologe 2012; 52:56-62. [DOI: 10.1007/s00117-011-2212-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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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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Frati A, Pichierri A, Bastianello S, Raco A, Santoro A, Esposito V, Giangaspero F, Salvati M. Frameless stereotactic cerebral biopsy: our experience in 296 cases. Stereotact Funct Neurosurg 2011; 89:234-45. [PMID: 21778794 DOI: 10.1159/000325704] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 02/12/2011] [Indexed: 11/19/2022]
Abstract
AIMS To evaluate the reliability, safety and accuracy of a the frameless stereotactic system in our clinical series and the differences between head fixation by means of a standard Mayfield head holder and the pinless FESS frame, and to evaluate the usefulness of biopsy targeting on the basis of magnetic resonance spectroscopy (MRS) data. METHODS The spectroscopic analysis was used to facilitate the targeting of the lesion. The fusion image function embedded in the Neuronavigation Unit was used postoperatively to assess the level of accuracy of the biopsy. The grading of the glioma specimens was correlated to the spectroscopic data. RESULTS 296 patients underwent cerebral biopsy in 8 years. The diagnostic yield was 99.7%. The spectroscopic choline/N-acetyl aspartate ratio in different areas of the same tumor correlated well with the histological grading of the lesion. CONCLUSION The frameless stereotactic systems guarantee excellent biopsy results. Advanced imaging, in particular MRS, facilitates the correct targeting of nonenhancing lesions.
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Amin DV, Lozanne K, Parry PV, Engh JA, Seelman K, Mintz A. Image-guided frameless stereotactic needle biopsy in awake patients without the use of rigid head fixation. J Neurosurg 2011; 114:1414-20. [DOI: 10.3171/2010.7.jns091493] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Image-guided frameless stereotactic techniques provide an alternative to traditional head-frame fixation in the performance of fine-needle biopsies. However, these techniques still require rigid head fixation, usually in the form of a head holder. The authors report on a series of fine-needle biopsies and brain abscess aspirations in which a frameless technique was used with a patient's head supported on a horseshoe headholder. To validate this technique, they performed an in vitro accuracy study.
Methods
Forty-eight patients underwent fine-needle biopsy of intracranial lesions that ranged in size from 0.9 to more than 107.7 ml; a fiducial-less, frameless, image-guided technique was used without rigid head fixation. In 1 of the 48 patients a cerebral abscess was drained. The accuracy study was performed with a skull phantom that was imaged with a CT scanner and tracked with a registration mask containing light-emitting diodes. The objective was a skin fiducial marker with a 4-mm circular target to accommodate the 2.5-mm biopsy needle. A series of 50 trials was conducted.
Results
Diagnostic tissue was obtained on the first attempt in 47 of 48 brain biopsy cases. In 2 cases small hemorrhages at the biopsy site were noted as a complication on the postoperative CT scan. One of these hemorrhages resulted in hand and arm weakness. The accuracy study demonstrated a 98% success rate of the biopsy needle passing through the 4-mm circular target using the registration mask as the registration and tracking device. This demonstrates a ± 0.75-mm tolerance on the targeting method.
Conclusions
The accuracy study demonstrated the ability of the mask to actively track the target and allow navigation to a 4-mm-diameter circular target with a 98% success rate. The frameless, pinless, fiducial-less technique described herein will likely be another safe, fast alternative to frame-based stereotactic techniques for fine-needle biopsy that avoids the potential morbidity of rigid head-pin fixation. Furthermore, it should lend itself to other image-guided applications such as the placement of ventricular catheters for shunting or Ommaya reservoirs.
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Shamir RR, Joskowicz L, Spektor S, Shoshan Y. Target and Trajectory Clinical Application Accuracy in Neuronavigation. Oper Neurosurg (Hagerstown) 2011; 68:95-101; discussion 101-2. [DOI: 10.1227/neu.0b013e31820828d9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Catheter, needle, and electrode misplacement in navigated neurosurgery can result in ineffective treatment and severe complications.
OBJECTIVE:
To assess the Ommaya ventricular catheter localization accuracy both along the planned trajectory and at the target.
METHODS:
We measured the localization error along the ventricular catheter and on its tip for 15 consecutive patients who underwent insertion of the Ommaya catheter surgery with a commercial neuronavigation system. The preoperative computed tomography/magnetic resonance images and the planned trajectory were aligned with the postoperative computed tomography images showing the Ommaya catheter. The localization errors along the trajectory and at the target were then computed by comparing the preoperative planned trajectory with the actual postoperative catheter position. The measured localization errors were also compared with the error reported by the navigation system.
RESULTS:
The mean localization errors at the target and entry point locations were 5.9 ± 4.3 and 3.3 ± 1.9 mm, respectively. The mean shift and angle between planned and actual trajectories were 1.6 ± 1.9 mm and 3.9 ± 4.7°, respectively. The mean difference between the localization error at the target and entry point was 3.9 ± 3.7 mm. The mean difference between the target localization error and the reported navigation system error was 4.9 ± 4.8 mm.
CONCLUSION:
The catheter localization errors have significant variations at the target and along the insertion trajectory. Trajectory errors may differ significantly from the errors at the target. Moreover, the single registration error number reported by the navigation system does not appropriately reflect the trajectory and target errors and thus should be used with caution to assess the procedure risk.
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Affiliation(s)
- Reuben R Shamir
- School of Engineering and Computer Science, The Hebrew University, Jerusalem, Israel
| | - Leo Joskowicz
- School of Engineering and Computer Science, The Hebrew University, Jerusalem, Israel
| | - Sergey Spektor
- Department of Neurosurgery, The Hebrew University Hadassah Medical Center, Jerusalem, Israel
| | - Yigal Shoshan
- Department of Neurosurgery, The Hebrew University Hadassah Medical Center, Jerusalem, Israel
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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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New prototype neuronavigation system based on preoperative imaging and intraoperative freehand ultrasound: system description and validation. Int J Comput Assist Radiol Surg 2010; 6:507-22. [PMID: 20886304 DOI: 10.1007/s11548-010-0535-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 09/13/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this report is to present IBIS (Interactive Brain Imaging System) NeuroNav, a new prototype neuronavigation system that has been developed in our research laboratory over the past decade that uses tracked intraoperative ultrasound to address surgical navigation issues related to brain shift. The unique feature of the system is its ability, when needed, to improve the initial patient-to-preoperative image alignment based on the intraoperative ultrasound data. Parts of IBIS Neuronav source code are now publicly available on-line. METHODS Four aspects of the system are characterized in this paper: the ultrasound probe calibration, the temporal calibration, the patient-to-image registration and the MRI-ultrasound registration. In order to characterize its real clinical precision and accuracy, the system was tested in a series of adult brain tumor cases. RESULTS Three metrics were computed to evaluate the precision and accuracy of the ultrasound calibration. 1) Reproducibility: 1.77 mm and 1.65 mm for the bottom corners of the ultrasound image, 2) point reconstruction precision 0.62-0.90 mm: and 3) point reconstruction accuracy: 0.49-0.74 mm. The temporal calibration error was estimated to be 0.82 ms. The mean fiducial registration error (FRE) of the homologous-point-based patient-to-MRI registration for our clinical data is 4.9 ± 1.1 mm. After the skin landmark-based registration, the mean misalignment between the ultrasound and MR images in the tumor region is 6.1 ± 3.4 mm. CONCLUSIONS The components and functionality of a new prototype system are described and its precision and accuracy evaluated. It was found to have an accuracy similar to other comparable systems in the literature.
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