Iversen Daniel Høyer, Wein Wolfgang, Lindseth Frank, Unsgård Geirmund, Reinertsen Ingerid
SINTEF Technology and Society, Department of Health Research, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University for Science and Technology, Trondheim, Norway.
ImFusion GmbH, München, Germany.
World Neurosurg. 2018 Dec;120:e1071-e1078. doi: 10.1016/j.wneu.2018.09.012. Epub 2018 Sep 11.
Unreliable neuronavigation owing to inaccurate patient-to-image registration and brain shift is a major problem in conventional magnetic resonance imaging-guided neurosurgery. We performed a prospective intraoperative validation of a system for fully automatic correction of this inaccuracy based on intraoperative three-dimensional ultrasound and magnetic resonance imaging-to-ultrasound registration.
The system was tested intraoperatively in 13 tumor resection cases, and performance was evaluated intraoperatively and postoperatively.
Intraoperatively, the system was accurate enough for tumor resection guidance in 9 of 13 cases. Manually placed anatomic landmarks showed improvement of alignment from 5.12 mm to 2.72 mm (median) after intraoperative correction. Postoperatively, the limitations of the current system were identified and modified for the system to be sufficiently accurate in all cases.
Automatic and accurate correction of spatially unreliable neuronavigation is feasible within the constraints of surgery. The current limitations of the system were also identified and addressed.
由于患者与图像配准不准确和脑移位导致的神经导航不可靠是传统磁共振成像引导神经外科手术中的一个主要问题。我们基于术中三维超声和磁共振成像到超声的配准，对一个用于全自动校正这种不准确的系统进行了前瞻性术中验证。
该系统在13例肿瘤切除病例中进行了术中测试，并在术中和术后对其性能进行了评估。
术中，该系统在13例中的9例中对肿瘤切除引导足够准确。手动放置的解剖标志在术中校正后，对齐改善从中位数5.12毫米至2.72毫米。术后，识别出当前系统的局限性并进行了修改，以使系统在所有病例中都足够准确。
在手术的限制范围内，对空间上不可靠的神经导航进行自动和准确的校正是可行的。还识别并解决了该系统当前的局限性。
