Combined frameless stereotactical biopsy and intraoperative cerebral angiography by 3D-rotational fluoroscopy with intravenous contrast administration: a feasibility study.
Aged
Aged, 80 and over
Brain Neoplasms
/ diagnostic imaging
Central Nervous System Fungal Infections
/ diagnostic imaging
Cerebral Angiography
/ methods
Cerebral Hemorrhage
/ diagnostic imaging
Contrast Media
/ administration & dosage
Feasibility Studies
Fluoroscopy
/ methods
Histoplasmosis
/ diagnostic imaging
Humans
Image-Guided Biopsy
/ methods
Imaging, Three-Dimensional
/ methods
Injections, Intravenous
Intraoperative Care
/ methods
Iodine
/ administration & dosage
Magnetic Resonance Imaging
/ methods
Male
Middle Aged
Neuronavigation
/ methods
Patient Positioning
3 D rotational fluoroscopy
Frameless systems
Intraoperative imaging
Neurosurgery
Stereotaxy
Journal
BMC medical imaging
ISSN: 1471-2342
Titre abrégé: BMC Med Imaging
Pays: England
ID NLM: 100968553
Informations de publication
Date de publication:
03 06 2021
03 06 2021
Historique:
received:
20
12
2020
accepted:
19
05
2021
entrez:
4
6
2021
pubmed:
5
6
2021
medline:
27
1
2022
Statut:
epublish
Résumé
Mobile 3-dimensional fluoroscopes are an integral part of modern neurosurgical operating theatres and can also be used in combination with free available image post processing to depict cerebral vessels. In preparation of stereotactic surgery, preoperative Computed Tomography (CT) may be required for image fusion. Contrast CT may be of further advantage for image fusion as it regards the vessel anatomy in trajectory planning. Time-consuming in-hospital transports are necessary for this purpose. Mobile 3D-fluoroscopes may be used to generate a CT equal preoperative data set without an in-hospital transport. This study was performed to determine the feasibility and image quality of intraoperative 3-dimensional fluoroscopy with intravenous contrast administration in combination with stereotactical procedures. 6 patients were included in this feasibility study. After fixation in a radiolucent Mayfield clamp a rotational fluoroscopy scan was performed with 50 mL iodine contrast agent. The image data sets were merged with the existing MRI images at a planning station and visually evaluated by two observer. The operation times were compared between the frame-based and frameless systems ("skin-to-skin" and "OR entry to exit"). The procedure proves to be safe. The entire procedure from fluoroscope positioning to the transfer to the planning station took 5-6 min with an image acquisition time of 24 s. In 5 of 6 cases, the fused imaging was able to reproduce the vascular anatomy accurately and in good quality. Both time end-points were significantly shorter compared to frame-based interventions. The images could easily be transferred to the planning and navigation system and were successfully merged with the MRI data set. The procedure can be completely integrated into the surgical workflow. Preoperative CT imaging or transport under anaesthesia may even be replaced by this technique in the future. Furthermore, hemorrhages can be successfully visualized intraoperatively and might prevent time delays in emergencies.
Sections du résumé
BACKGROUND
Mobile 3-dimensional fluoroscopes are an integral part of modern neurosurgical operating theatres and can also be used in combination with free available image post processing to depict cerebral vessels. In preparation of stereotactic surgery, preoperative Computed Tomography (CT) may be required for image fusion. Contrast CT may be of further advantage for image fusion as it regards the vessel anatomy in trajectory planning. Time-consuming in-hospital transports are necessary for this purpose. Mobile 3D-fluoroscopes may be used to generate a CT equal preoperative data set without an in-hospital transport. This study was performed to determine the feasibility and image quality of intraoperative 3-dimensional fluoroscopy with intravenous contrast administration in combination with stereotactical procedures.
METHODS
6 patients were included in this feasibility study. After fixation in a radiolucent Mayfield clamp a rotational fluoroscopy scan was performed with 50 mL iodine contrast agent. The image data sets were merged with the existing MRI images at a planning station and visually evaluated by two observer. The operation times were compared between the frame-based and frameless systems ("skin-to-skin" and "OR entry to exit").
RESULTS
The procedure proves to be safe. The entire procedure from fluoroscope positioning to the transfer to the planning station took 5-6 min with an image acquisition time of 24 s. In 5 of 6 cases, the fused imaging was able to reproduce the vascular anatomy accurately and in good quality. Both time end-points were significantly shorter compared to frame-based interventions.
CONCLUSION
The images could easily be transferred to the planning and navigation system and were successfully merged with the MRI data set. The procedure can be completely integrated into the surgical workflow. Preoperative CT imaging or transport under anaesthesia may even be replaced by this technique in the future. Furthermore, hemorrhages can be successfully visualized intraoperatively and might prevent time delays in emergencies.
Identifiants
pubmed: 34082701
doi: 10.1186/s12880-021-00622-3
pii: 10.1186/s12880-021-00622-3
pmc: PMC8173902
doi:
Substances chimiques
Contrast Media
0
Iodine
9679TC07X4
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
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