C-arm fluoroscopic cone beam CT for guidance of minimally invasive spine interventions.
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BACKGROUND: Isocentric C-arm fluoroscopic cone beam CT (CBCT) is a new technique for near real time 3-D volume imaging guidance of percutaneous interventional procedures. In combination with digital flat panel detectors, CBCT has high spatial resolution with isotropic voxel size, allowing for high resolution image reconstruction in any plane, including 3D rotational reconstructions. CBCT combines the advantages of conventional CT imaging guidance with the improved spatial resolution, patient positioning, and access of fluoroscopy. OBJECTIVE: The aim of this study is to demonstrate the advantages of CBCT over conventional CT and biplane fluoroscopy for imaging guidance of minimally invasive spinal and paraspinal interventional procedures. METHODS: Five patients referred to the department of interventional neuroradiology for percutaneous spinal or paraspinal interventional procedures were intraoperatively evaluated with CBCT to assist in guidance of instrumentation placement. Procedures included transoral cervical vertebral biopsy, percutaneous thoracic vertebral biopsy, vertebroplasty, pelvic paraspinal/epidural abscess drainage, and paraspinal fiducial marker placement for treatment of osteoid osteoma. RESULTS: All procedures were successfully performed with satisfactory diagnostic yield or therapeutic effect without procedure-related complications. CONCLUSION: Isocentric C-arm fluoroscopic cone beam CT (CBCT) is a new technique for 3D volume imaging guidance of interventional procedures of the spine with the capability to produce near real time high resolution image reconstructions in any plane. Compared to conventional CT and biplane fluoroscopy, CBCT offers improved anatomic visualization allowing high accuracy instrumentation placement, improving procedure results and minimizing risk of complications. (+info)
Stereotactic electroencephalography with temporal grid and mesial temporal depth electrode coverage: does technique of depth electrode placement affect outcome?
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Preoperative surgical approach planning for metastatic pituitary stalk tumor using multimodal fusion imaging in a neuronavigation system--case report.
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A 72-year-old woman presented with a metastatic brain tumor around the pituitary stalk compressing the chiasm anteriorly and upward. After tumor resection by a left pterional approach failed, a three-dimensional (3D) image of the area of interest was reconstructed using the Vecter Vision navigation system and iPlan Cranial planning software version 2.5. Preoperative 3D computed tomography and magnetic resonance imaging data were fused to demonstrate the anatomical relationship between vessels, nerves, and tumor. Clearer demonstration of the optic nerves utilized thin slice axial and sagittal views along the nerves. The 3D reconstructed image demonstrated the spatial relationship of the tumor and surrounding tissue, and suggested the necessity of a right orbitozygomatic approach to create adequate working space for tumor resection. Second surgery according to this preoperative planning was successful. High quality multimodal fusion images in a navigation system has distinct advantages in preoperative assessment of essential structural relationships allowing adequate exposure of certain lesions and surrounding structures in individual patients by defining specific surgical approaches. (+info)
Evaluation of intraoperative brain shift using an ultrasound-linked navigation system for brain tumor surgery.
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Image-guided neurosurgery using navigation systems is an essential tool to increase accuracy in brain tumor surgery. However, brain shift during surgery has remained problematic. The present study evaluated the utility of a new ultrasound (US)-linked navigation system for brain tumor surgery in 64 patients with intracranial tumors. The navigation system consisted of a StealthStation navigation system, a SonoNav system, and a standard US scanner. This system determines the orientation of the US images and reformats the images from preoperative computed tomography (CT) or magnetic resonance (MR) imaging to match the US images. The system was used intraoperatively to measure brain shift several times, using the results to guide tumor resection. US-linked navigation provided information regarding brain shift, and extent of tumor resection during surgery. Evaluation of brain shift was easily achieved in all patients, without using intraoperative CT or MR imaging. Accurate information regarding the true anatomical configuration of the patient could be obtained in all phases of the operation. Magnitude of brain shift increased progressively from pre- to post-resection and depended on the type of cranial structure. Integration of the US scanner with the navigation system allowed comparisons between the intraoperative US and preoperative images, thus improving interpretation of US images. The system also improved the rate of tumor resection by facilitating the detection of remnant tumor tissue. This US-linked navigation system provides information on brain shift, and improves the accuracy and utility of image-guided surgery. (+info)
Intraoperative intracerebral MRI-guided navigation for accurate targeting in nonhuman primates.
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