Department of Surgery - Otolaryngology, Head and Neck Surgery, The University of Adelaide, Basil Hetzel Institute for Translational Research, Woodville South, Adelaide, Australia; Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia; Department of Neurosurgery, Flinders Medical Centre, Adelaide, Australia.
Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, Australia.
J Clin Neurosci. 2024 May;123:203-208. doi: 10.1016/j.jocn.2024.04.006. Epub 2024 Apr 11.
Neuronavigation is common technology used by skull base teams when performing endoscopic endonasal surgery. A common practice of MRI imagining is to obtain 3D isotopic gadolinium enhanced T1W magnetisation prepared rapid gradient echo (MPRAGE) sequences. These are prone to distortion when undertaken on 3 T magnets. The aim of this project is to compare the in vivo accuracy of MRI sequences between current and new high resolution 3D sequences. The goal is to determine if geometric distortion significantly affects neuronavigation accuracy.
Patients were scanned with a 3D T1 MPRAGE sequence, 3D T1 SPACE sequence and a CT stereotactic localisation. Following general anaesthesia, patients were registered on the Stealth Station (Medtronic, USA) using a side mount emitter for Electromagnetic navigation. A variety of surgically relevant anatomical landmarks in the sagittal and coronal plane were selected with real and virtual data points measured.
A total of 10 patients agreed be enrolled in the study with datapoints collected during surgery. The distance between real and virtual datapoints trended to be lower in SPACE sequences compared to MPRAGE. Paired t test did not demonstrate a significant difference.
We have demonstrated that navigational accuracy is not significantly affected by the type of MRI sequence selected and that current corrective algorithms are sufficient. Navigational accuracy is affected by many factors, with registration error likely playing the most significant role. Further research involving real time imaging such as endoscopic ultrasound may hopefully address this potential error.
神经导航是经颅底内镜手术团队常用的技术。磁共振成像的一种常见做法是获取三维同位素钆增强 T1W 磁共振成像快速梯度回波（MPRAGE）序列。这些序列在 3T 磁体上进行时容易发生变形。本项目旨在比较当前和新的高分辨率 3D 序列之间的 MRI 序列的体内准确性。目的是确定几何变形是否显著影响神经导航的准确性。
对患者进行三维 T1 MPRAGE 序列、三维 T1 SPACE 序列和 CT 立体定位扫描。全身麻醉后，使用侧装发射器在 Stealth Station（美国美敦力）上对患者进行注册，用于电磁导航。在矢状面和冠状面选择了各种与手术相关的解剖学标志，并测量了真实和虚拟数据点。
共有 10 名患者同意参与研究，在手术过程中收集了数据点。SPACE 序列中真实和虚拟数据点之间的距离趋势低于 MPRAGE 序列。配对 t 检验未显示出显著差异。
我们已经证明，导航准确性不受所选 MRI 序列类型的显著影响，并且当前的校正算法是足够的。导航准确性受许多因素影响，其中注册误差可能起着最重要的作用。涉及实时成像（如内镜超声）的进一步研究可能有望解决此潜在误差。
