Mahvash Mehran, Boettcher Ioannis, Petridis Athanasios K, Besharati Tabrizi Leila
Department of Neurosurgery, Clinic of Köln-Merheim, University of Witten-Herdecke, Witten-Herdecke, Germany.
J Neurosurg Sci. 2017 Feb;61(1):8-13. doi: 10.23736/S0390-5616.16.03142-8. Epub 2015 Jan 20.
Accurate brain lesion and craniotomy localization is an essential step in neurosurgical procedures. Image guided techniques transfer the information of neuroimaging about brain lesion localization to the patient. A critical view is necessary to find out how safe and reliable it is to transfer this information to the patient's head without using image guided systems. The aim of this study was to investigate the value of image guided brain lesion and craniotomy localization compared to conventional methods.
A new developed test was performed with 10 neurosurgeons from different clinics. The first task was to perform the conventional tumor localization, planning of craniotomy and skin incision using the MRI dataset of a patient with a left temporal brain tumor. Second, the neurosurgeons were asked to plan the craniotomy and skin incision using MRI based 3D visualization with the exact localization of the segmented brain tumor. Both plans of each neurosurgeon were compared and analyzed according to the calculated brain tumor localization, location, shape and size of craniotomy.
All neurosurgeons changed the craniotomy localization and skin incision in the second part of the task using the image guided tumor visualization. The mean error (±standard deviation) of tumor localization of the conventional planning was 11.45±5.09 mm in the anterior-posterior (AP) and 12±7.91 mm in the superior-inferior (SI) direction. The mean error of the craniotomy localization using conventional planning was 10.18±6.09 mm in the AP and 10.75±8.18 mm in the SI direction. The craniotomy size was significantly larger using conventional planning of the craniotomy (P=0.035).
Conventional brain tumor and craniotomy localization leads more frequently to errors and oversized craniotomy. Image guided surgery can reduce these errors and increase the safety and orientation for preoperative planning.
准确的脑病变和开颅手术定位是神经外科手术中的关键步骤。图像引导技术将神经影像学关于脑病变定位的信息传递给患者。至关重要的是要弄清楚在不使用图像引导系统的情况下，将此信息传递到患者头部的安全性和可靠性如何。本研究的目的是探讨与传统方法相比，图像引导脑病变和开颅手术定位的价值。
对来自不同诊所的10名神经外科医生进行了一项新开发的测试。第一项任务是使用一名左侧颞叶脑肿瘤患者的MRI数据集进行传统的肿瘤定位、开颅手术规划和皮肤切口规划。其次，要求神经外科医生使用基于MRI的3D可视化技术，在精确分割脑肿瘤定位的情况下规划开颅手术和皮肤切口。根据计算出的脑肿瘤定位、开颅手术的位置、形状和大小，对每位神经外科医生的两种规划进行比较和分析。
在任务的第二部分，所有神经外科医生使用图像引导的肿瘤可视化技术改变了开颅手术的定位和皮肤切口。传统规划的肿瘤定位在前后（AP）方向的平均误差（±标准差）为11.45±5.09mm，在上下（SI）方向为12±7.91mm。使用传统规划的开颅手术定位在AP方向的平均误差为10.18±6.09mm，在SI方向为10.75±8.18mm。使用传统开颅手术规划时，开颅手术的尺寸明显更大（P=0.035）。
传统的脑肿瘤和开颅手术定位更容易导致误差和开颅手术过大。图像引导手术可以减少这些误差，并提高术前规划的安全性和方向性。
