Intraoperative Imaging Modalities and Compensation for Brain Shift in Tumor Resection Surgery.

Siming Bayer,Martin Ostermeier,Rebecca Fahrig,Andreas Maier

doi:10.1155/2017/6028645

Abstract

Intraoperative brain shift during neurosurgical procedures is a well-known phenomenon caused by gravity, tissue manipulation, tumor size, loss of cerebrospinal fluid (CSF), and use of medication. For the use of image-guided systems, this phenomenon greatly affects the accuracy of the guidance. During the last several decades, researchers have investigated how to overcome this problem. The purpose of this paper is to present a review of publications concerning different aspects of intraoperative brain shift especially in a tumor resection surgery such as intraoperative imaging systems, quantification, measurement, modeling, and registration techniques. Clinical experience of using intraoperative imaging modalities, details about registration, and modeling methods in connection with brain shift in tumor resection surgery are the focuses of this review. In total, 126 papers regarding this topic are analyzed in a comprehensive summary and are categorized according to fourteen criteria. The result of the categorization is presented in an interactive web tool. The consequences from the categorization and trends in the future are discussed at the end of this work.

Highlights

In neurosurgery, one of the major challenges is localization of the pathological tissue and relevant anatomical structures within the brain during surgery
The extent of brain shift was already described in 1986 by Kelly et al [4]. It was observed as the displacement of small steel reference balls which were inserted along the stereotaxis surgical viewline before craniotomy
Publications focusing on Deep Brain Stimulation (DBS), which is a minimally invasive therapeutic procedure, and papers dealing with Diffusion Tensor Imaging (DTI), which is often used for preoperative planning but does not fit the real time constraint in lesion removal surgery, are excluded

Summary

Introduction

One of the major challenges is localization of the pathological tissue and relevant anatomical structures within the brain during surgery. ImageGuided Neurosurgical Systems (IGNS) help to overcome this challenge Such systems register preoperative image data to an intraoperative coordinate system of the patient, in order to display the rendering of the brain structure and position of the region of interest. To guarantee the precise localization of pathological tissue during surgery, a high rate of correlation between the preoperative image data and the patient anatomy is necessary. This correlation is strongly limited by the intraoperative deformation of brain tissue, the so-called brain shift phenomenon. The correlation of structures identified in the preoperative image data and in the actual image data

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Conclusion