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皮肤移位及其对图像引导神经外科手术中导航准确性的影响。

Skin shift and its effect on navigation accuracy in image-guided neurosurgery.

作者信息

Mitsui Takashi, Fujii Masazumi, Tsuzaka Masatoshi, Hayashi Yuichiro, Asahina Yoshinori, Wakabayashi Toshihiko

机构信息

Graduate School of Medical Science, Nagoya University, 1-1-20 Daiko-minami, Higashi, Nagoya, 461-8673, Japan.

出版信息

Radiol Phys Technol. 2011 Jan;4(1):37-42. doi: 10.1007/s12194-010-0103-0. Epub 2010 Sep 10.

Abstract

Neuronavigation systems have been developed for image-guided neurosurgery to aid in the accurate resection of malignant brain tumors. Therefore, the accuracy of the neuronavigation is important. However, many factors can reduce the navigation accuracy during surgery. Before craniotomy, the patient's head is secured to a head frame with head pins; this fixation may cause displacement of fiducial markers and reduce the accuracy. We term this phenomenon skin shift. In this study, the extent of skin shift and its effect on navigation accuracy were determined by use of both preoperative magnetic resonance imaging (MRI) scans acquired before fixation and intraoperative MRI scans acquired after fixation. We measured the displacement of the fiducial markers by using fusion images obtained by integrating preoperative and intraoperative MRI scans. We also evaluated the navigation accuracy of registration based on preoperative and on intraoperative MRI. The mean (± SD) extent of skin shift was 5.34 (± 2.65) mm. The navigation accuracy of registration based on preoperative MRI was 4.06 (± 2.25) mm, and that of registration based on intraoperative MRI was 2.51 (± 1.32) mm. No significant correlation was observed between the extent of skin shift and the distance between the head pins and fiducial markers (p > 0.05). The navigation accuracy of registration based on intraoperative MRI was significantly higher than that of registration based on preoperative MRI (p < 0.001). The results indicated that skin shift was caused by the fixation, and that this shift reduced the navigation accuracy. Intraoperative MRI can correct the effect of skin shift.

摘要

神经导航系统已被开发用于图像引导神经外科手术,以辅助精确切除恶性脑肿瘤。因此,神经导航的准确性很重要。然而,许多因素会在手术过程中降低导航准确性。在开颅手术前,患者头部用头钉固定在头架上;这种固定可能会导致基准标记移位并降低准确性。我们将这种现象称为皮肤移位。在本研究中,通过使用固定前获取的术前磁共振成像(MRI)扫描和固定后获取的术中MRI扫描来确定皮肤移位的程度及其对导航准确性的影响。我们通过整合术前和术中MRI扫描获得的融合图像来测量基准标记的位移。我们还评估了基于术前和术中MRI的配准导航准确性。皮肤移位的平均(±标准差)程度为5.34(±2.65)mm。基于术前MRI的配准导航准确性为4.06(±2.25)mm,基于术中MRI的配准导航准确性为2.51(±1.32)mm。皮肤移位程度与头钉和基准标记之间的距离未观察到显著相关性(p>0.05)。基于术中MRI的配准导航准确性显著高于基于术前MRI的配准导航准确性(p<0.001)。结果表明,皮肤移位是由固定引起的,并且这种移位降低了导航准确性。术中MRI可以纠正皮肤移位的影响。

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