Lutz Weise1, S Eibach, V Seifert, M Setzer. 1. Klinik für Neurochirurgie, Goethe Universität Frankfurt am Main, Germany. lutz.weise@med.uni-frankfurt.de
Abstract
BACKGROUND: Intraoperative localisation of a stereotactic probe remains challenging. Stereotactic X-ray, the "gold standard", as well as intraoperative magnetic resonance (MRI) and computed tomography (CT), require a dedicated operating room (OR). Fluoroscopy with crosshairs confirms only grossly the target position. An alternative would be a mobile three-dimensional (3D) fluoroscopy C-arm. To our knowledge, this is the first report on 3D C-arm fluoroscopy to verify stereotactical trajectories. The objective was to assess the feasibility of using a 3D C-arm to verify the intraoperative trajectory and target. METHODS: A total of 12 stereotactic trajectories in 10 patients were analysed, comprising 8 biopsies and 4 electrode trajectories. The fluoroscopic scan was performed after implantation of the deep brain stimulation electrode or after advancing the biopsy needle to the tumour. An image set is acquired during a rotation of the 3D C-arm. The image set is reconstructed and merged to the preoperative CT scan. Calculating the vector error and the deviation assesses target and trajectory accuracy. RESULTS: The mean trajectory deviation was 0.6 mm (±0.54 mm) and the mean vector error was 1.44 mm (±1.43 mm). There was no influence on the surgical time and the mean irradiation dosage was 401.9 cGycm(2). CONCLUSIONS: This target and trajectory verification is feasible. Its accuracy seems comparable with MRI and CT. There is no additional time consumption. Irradiation is comparable with stereotactic X-ray.
BACKGROUND: Intraoperative localisation of a stereotactic probe remains challenging. Stereotactic X-ray, the "gold standard", as well as intraoperative magnetic resonance (MRI) and computed tomography (CT), require a dedicated operating room (OR). Fluoroscopy with crosshairs confirms only grossly the target position. An alternative would be a mobile three-dimensional (3D) fluoroscopy C-arm. To our knowledge, this is the first report on 3D C-arm fluoroscopy to verify stereotactical trajectories. The objective was to assess the feasibility of using a 3D C-arm to verify the intraoperative trajectory and target. METHODS: A total of 12 stereotactic trajectories in 10 patients were analysed, comprising 8 biopsies and 4 electrode trajectories. The fluoroscopic scan was performed after implantation of the deep brain stimulation electrode or after advancing the biopsy needle to the tumour. An image set is acquired during a rotation of the 3D C-arm. The image set is reconstructed and merged to the preoperative CT scan. Calculating the vector error and the deviation assesses target and trajectory accuracy. RESULTS: The mean trajectory deviation was 0.6 mm (±0.54 mm) and the mean vector error was 1.44 mm (±1.43 mm). There was no influence on the surgical time and the mean irradiation dosage was 401.9 cGycm(2). CONCLUSIONS: This target and trajectory verification is feasible. Its accuracy seems comparable with MRI and CT. There is no additional time consumption. Irradiation is comparable with stereotactic X-ray.
Authors: Shaun R Patel; Sameer A Sheth; Clarissa Martinez-Rubio; Matthew K Mian; Wael F Asaad; Jason L Gerrard; Churl-Su Kwon; Darin D Dougherty; Alice W Flaherty; Benjamin D Greenberg; John T Gale; Ziv M Williams; Emad N Eskandar Journal: Nat Protoc Date: 2013-04-18 Impact factor: 13.491
Authors: Thomas Linsenmann; Andrea Cattaneo; Alexander März; Judith Weiland; Christian Stetter; Robert Nickl; Thomas Westermaier Journal: BMC Med Imaging Date: 2021-06-03 Impact factor: 1.930