Abstract
Conventionally, surgery and procedural-based radiology are performed on different premises. With advances in imaging technology, the operating room is rapidly being transformed into an intraoperative imaging suite. Diagnostic imaging in conjunction with surgery has great utility and by all accounts has great future potential. During the last decade, cone beam computed tomography (CT) scanners have been introduced and have made intraoperative imaging more feasible because these scanners can be made less bulky. The current usefulness of intraoperative magnetic resonance imaging (MRI) or CT for neurosurgery, however, is impaired by the lack of completely radiolucent skull clamps, causing image artifacts. Metal artifacts are particularly problematic, given that they lead to a considerably higher image quality degradation factor for cone beam CT scanners than for conventional CT scanners. Here, we describe our experience with near-radiolucent skull clamps and their associated problems and discuss future improvements to facilitate high-quality image guidance in the field of neurosurgery.
Highlights
One of the most commonly used skull clamps today, a three-pin skull clamp that rigidly affixes a patient's head to the operating table was designed by Frank H
The Mayfield skull clamp has proven to be flexible, allowing stable fixation and good accessibility in the supine, prone and oblique positions and it has remained largely unchanged since its creation
The artifacts described above present a major problem for surgeons, in reducing the medical usefulness of developed X-ray pictures. To overcome these problems skull clamps have been constructed with radiolucent material; they are not 100% radiolucent as we demonstrate in this article
Summary
One of the most commonly used skull clamps today, a three-pin skull clamp that rigidly affixes a patient's head to the operating table was designed by Frank H. The artifacts described above present a major problem for surgeons, in reducing the medical usefulness of developed X-ray pictures To overcome these problems skull clamps have been constructed with radiolucent material; they are not 100% radiolucent as we demonstrate in this article. Figure. depicts the results of four near-radiolucent skull clamps Both of the Mayfield clamps and the Doro clamp, to a lesser extent, (Fig. 1A-C) suffer from metal artifacts due to a spring in the one pinned arm. The entire field of view is obscured by alternating black and white lines which are an expected difference [6, 8,9,10,11] when cone beam CT is used compared with conventional CT (Fig. 1) Another possible explanation could be patient motion, which is known to cause this type of artifact [2].
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