A First Indian Retrospective Study of Intraoperative Computed Tomography Use in Neurosurgery with 75 Cases - Charting New Frontiers

Abstract

Background: Intraoperative visualization of surgical anatomy is crucial for precision and accuracy in neurosurgical interventions. Traditional navigation systems are hampered by physiological changes such as brain shift, potentially compromising surgical accuracy. This study, the first of its kind in India, investigates the application of intraoperative computed tomography (iCT) and discusses our collective experience with its use in surmounting these challenges, offering a comprehensive insight into its adoption in neurosurgical practices. Methodology: We conducted a retrospective analysis of 75 patients (mean age 44, range 12-75; 42 males and 35 females) who underwent neurosurgical operations with an iCT during preoperative, intraoperative, and postoperative phases. The cohort included 110 scans, 82 for brain surgeries among 50 patients, and 28 for spine surgeries among 25 patients. Results: iCT was adaptable to both brain and spine surgeries, with intraoperative findings generally correlating with postoperative CT scans. Navigation errors were observed in 50% (n = 10/20) of brain surgery cases, with a mean deviation of 4.0-5.0 mm, and in 17% of spine surgeries(n=5). iCT played a critical role in influencing surgical decision-making in 11 cases, which may have reduced the incidence of complications. While the average surgery time increased to 220 minutes, experience led to more efficient scan times, decreasing from 45 to 20 minutes. Radiation exposure was also reduced from 1200 to 600 milligrays. The overall complication rate was low at 6%. Conclusions: iCT may serve as an effective tool for enhancing intraoperative visualization, potentially addressing some of the current limitations associated with physiological changes in traditional neurosurgical navigation. While our findings suggest an improvement in surgical precision and a reduction in complication rates, further studies are required to more robustly evaluate the long-term impact of iCT on patient outcomes in the Indian subcontinent.