Abstract
BackgroundBrain biopsies are crucial diagnostic interventions, providing valuable information for treatment and prognosis, but largely depend on a high accuracy and precision. We hypothesized that through the combination of neuronavigation-based frameless stereotaxy and MRI-guided trajectory planning with intraoperative CT examination using a mobile unit, one can achieve a seamlessly integrated approach yielding optimal target accuracy.MethodsWe analyzed a total of 7 stereotactic biopsy trajectories for a variety of deep-seated locations and different patient positions. After rigid head fixation, an intraoperative pre-procedural scan using a mobile CT unit was performed for automatic image fusion with the planning MRI images and a peri-procedural scan with the biopsy cannula in situ for verification of the definite target position. We then evaluated the radial trajectory error.ResultsIntraoperative scanning, surgery, computerized merging of MRI and CT images as well as trajectory planning were feasible without difficulties and safe in all cases. We achieved a radial trajectory deviation of 0.97 ± 0.39 mm at a trajectory length of 60 ± 12.3 mm (mean ± standard deviation). Repositioning of the biopsy cannula due to inaccurate targeting was not required.ConclusionIntraoperative verification using a mobile CT unit in combination with frameless neuronavigation-guided stereotaxy and pre-operative MRI-based trajectory planning was feasible, safe and highly accurate. The setting enabled single-millimeter accuracy for deep-seated brain lesions and direct detection of intraoperative complications, did not depend on a dedicated operating room and was seamlessly integrated into common stereotactic procedures.
Highlights
IntroductionBichsel et al BMC Neurol (2021) 21:285 intraoperative imaging, formerly blind stereotactic approaches have been transformed into visually controlled, highly accurate procedures
We focused on the radial trajectory deviation as a measure of accuracy, and not for instance the Euclidean error vector, as the depth of the cannula along an accurate trajectory can be changed with relative ease when an intraoperative image is available
Accuracy Intraoperative imaging for pre-procedural image merging (Fig. 2) as well as peri-procedural to verify the position of the biopsy cannula was successful in all patients
Summary
Bichsel et al BMC Neurol (2021) 21:285 intraoperative imaging, formerly blind stereotactic approaches have been transformed into visually controlled, highly accurate procedures. A decisive advantage of intraoperative probe localization is that it allows trajectory modifications during surgery, thereby eliminating misdiagnosis secondary to faulty targeting or brain-shift. For deep-seated intracerebral lesions, intraoperative image-guided biopsy techniques have been shown to be superior to other techniques [2, 3]. Despite the known superiority of real-time volumetric intraoperative imaging using MRI [11, 15] for the localization of probe targets, stereotactic X-ray and fluoroscopy are still in common use [20]. We hypothesized that through the combination of neuronavigation-based frameless stereotaxy and MRI-guided trajectory planning with intraoperative CT examination using a mobile unit, one can achieve a seamlessly integrated approach yielding optimal target accuracy
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