Department of Neurosurgery, The Hospital of the University of Pennsylvania, 801 Spruce Street, 8th Floor, Philadelphia, PA, 19107, USA.
Perelman School of Medicine, The University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA.
Mol Imaging Biol. 2020 Dec;22(6):1572-1580. doi: 10.1007/s11307-020-01495-8.
Frameless neuronavigation allows neurosurgeons to visualize and relate the position of surgical instruments to intracranial pathologies based on preoperative tomographic imaging. However, neuronavigation can often be inaccurate. Multiple factors have been proposed as potential causes, and new technologies are needed to overcome these challenges.
To evaluate the accuracy of neuronavigation systems compared to near-infrared (NIR) fluorescence imaging using Second Window Indocyanine Green, a novel technique, and to determine factors that lead to neuronavigation errors.
A retrospective analysis was conducted on 56 patients who underwent primary resections of intracranial tumors. Patients received 5 mg/kg ICG approximately 24 h preoperatively. Intraoperatively, neuronavigation was used to plan craniotomies to place the tumors in the center. After craniotomy, NIR imaging visualized tumor-specific NIR signals. The accuracy of neuronavigation and NIR fluorescence imaging for delineating the tumor boundary prior to durotomy was compared.
The neuronavigation centers and NIR centers were 23.0 ± 7.7 % and 2.6 ± 1.1 % deviated from the tumor centers, respectively, relative to the craniotomy sizes. In 12 cases, significant changes were made to the planned durotomy based on NIR imaging. Patient position was a significant predictor of neuronavigation inaccuracy on both univariate and multivariate analysis, with the prone position having significantly higher inaccuracy (29.2 ± 8.1 %) compared to the supine (16.2 ± 8.1 %, p value < 0.001) or the lateral (17.9 ± 5.1 %, p value = 0.003) positions.
Patient position significantly affects neuronavigation accuracy. Intraoperative NIR fluorescence imaging before durotomy offers an opportunity to readjust the neuronavigation image space to better align with the patient space.
无框架神经导航允许神经外科医生根据术前断层成像来可视化和关联手术器械的位置与颅内病变。然而，神经导航往往不够准确。已经提出了多种潜在原因，需要新技术来克服这些挑战。
评估使用新型技术近红外（NIR）荧光成像的神经导航系统的准确性，并确定导致神经导航误差的因素。
对 56 例接受颅内肿瘤初次切除术的患者进行了回顾性分析。患者在术前约 24 小时接受 5mg/kg ICG。术中，使用神经导航规划开颅术，使肿瘤位于中央。开颅后，NIR 成像可视化肿瘤特异性 NIR 信号。比较神经导航和 NIR 荧光成像在硬脑膜切开前勾画肿瘤边界的准确性。
神经导航中心和 NIR 中心分别偏离颅切开大小的肿瘤中心 23.0±7.7%和 2.6±1.1%。在 12 例中，根据 NIR 成像对计划的硬脑膜切开术进行了重大修改。患者体位是神经导航不准确的显著预测因素，无论是单变量还是多变量分析，俯卧位的不准确程度明显高于仰卧位（29.2±8.1%）和侧卧位（17.9±5.1%）（p 值均<0.001）。
患者体位显著影响神经导航的准确性。硬脑膜切开术前的术中 NIR 荧光成像为重新调整神经导航图像空间以更好地与患者空间对齐提供了机会。
