Abstract
BackgroundMobile 3-dimensional fluoroscopes are an integral part of modern neurosurgical operating theatres and can also be used in combination with free available image post processing to depict cerebral vessels. In preparation of stereotactic surgery, preoperative Computed Tomography (CT) may be required for image fusion. Contrast CT may be of further advantage for image fusion as it regards the vessel anatomy in trajectory planning. Time-consuming in-hospital transports are necessary for this purpose. Mobile 3D-fluoroscopes may be used to generate a CT equal preoperative data set without an in-hospital transport. This study was performed to determine the feasibility and image quality of intraoperative 3-dimensional fluoroscopy with intravenous contrast administration in combination with stereotactical procedures.Methods6 patients were included in this feasibility study. After fixation in a radiolucent Mayfield clamp a rotational fluoroscopy scan was performed with 50 mL iodine contrast agent. The image data sets were merged with the existing MRI images at a planning station and visually evaluated by two observer. The operation times were compared between the frame-based and frameless systems (“skin-to-skin” and “OR entry to exit”).ResultsThe procedure proves to be safe. The entire procedure from fluoroscope positioning to the transfer to the planning station took 5–6 min with an image acquisition time of 24 s. In 5 of 6 cases, the fused imaging was able to reproduce the vascular anatomy accurately and in good quality. Both time end-points were significantly shorter compared to frame-based interventions.ConclusionThe images could easily be transferred to the planning and navigation system and were successfully merged with the MRI data set. The procedure can be completely integrated into the surgical workflow. Preoperative CT imaging or transport under anaesthesia may even be replaced by this technique in the future. Furthermore, hemorrhages can be successfully visualized intraoperatively and might prevent time delays in emergencies.
Highlights
Mobile 3-dimensional fluoroscopes are an integral part of modern neurosurgical operating theatres and can be used in combination with free available image post processing to depict cerebral vessels
The patient has to be transferred to the Computed Tomography (CT) scanner which means for a prolonged period under anesthesia if it is performed under general anesthesia (GA) or increased stress in case of local anesthesia
This study evaluated the modalities of image acquisition and image quality of 3-D fluoroscopy after intravenous contrast administration in patients with intracranial tumors undergoing stereotactical procedures
Summary
Mobile 3-dimensional fluoroscopes are an integral part of modern neurosurgical operating theatres and can be used in combination with free available image post processing to depict cerebral vessels. In preparation of stereotactic surgery, preoperative Computed Tomography (CT) may be required for image fusion. Contrast CT may be of further advantage for image fusion as it regards the vessel anatomy in trajectory planning. Mobile 3D-fluoroscopes may be used to generate a CT equal preoperative data set without an in-hospital transport. This study was performed to determine the feasibility and image quality of intraoperative 3-dimensional fluoroscopy with intravenous contrast administration in combination with stereotactical procedures. The patient has to be transferred to the CT scanner which means for a prolonged period under anesthesia if it is performed under general anesthesia (GA) or increased stress in case of local anesthesia. In-hospital transports are associated with significantly increased risks for patients to suffer pulmonary and cardiovascular complications [4]
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