A Computer-Assisted Device for the Intraoperative CT-Correlated Localization of Brain Tumors

Reinhardt, H; Meyer, Henning; E, Amrein

doi:10.1159/000128741

Cited by 66 publications

(27 citation statements)

References 13 publications

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“…A reliable localization of all lesions at the beginning of surgical procedures was possible, and this is conform with results in the recent literature [6,8,[11][12][13][14]. Initial ex pectations and the desired aim to control the degree of tumor resection by CAL were not fulfilled, because continuous debulking of the lesion and the consecutive extension of the surrounding and compressed brain tissue per manently alter anatomical situations [2], Therefore, the progressive decrease in accura cy is inevitable, because CAL works with inappropriate and not actualized data which are based on preoperative neuroradiological images [3].…”

Section: Discussionsupporting

confidence: 88%

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The Computer-Assisted Localizer, a Navigational Help in Microneurosurgery

Spetzger

Gilsbach²,

Mösges³

et al. 1997

Eur Surg Res

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The computer-assisted-localizer (CAL) achieves a direct linkage between preoperative radiological images and individual intraoperative anatomical findings. Experiences with our system demonstrate that CAL improves the intraoperative orientation and facilitates the neurosurgical procedure. The system described here consists of a mechanical articulated robot arm with six degrees of freedom and a three-dimensional image processor. After calibration, the displayed image dynamically pointed out the exact intraoperative localization in three perpendicular sectional views. Meanwhile, CAL was successfully used in 73 selected microneurosurgical procedures.

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Section: Discussionsupporting

confidence: 88%

“…Since 1987, several neuronavigator sys tems have been developed for intraoperative localization [5][6][7][8] during neurosurgical proce dures. The first benefit of these devices is the capability of dynamical three-dimensional re construction of neuroradiological images, fa cilitating the preoperative planning of the neurosurgical strategy.…”

Section: Discussionmentioning

confidence: 99%

The Computer-Assisted Localizer, a Navigational Help in Microneurosurgery

Spetzger

Gilsbach²,

Mösges³

et al. 1997

Eur Surg Res

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show abstract

“…Furthermore, they have to be fixed to the patient's head invasively and do not allow interactive, image-guided surgery in real time. These facts and technical progresses, especially in computer science, at the end of the 1980s encouraged several research groups [13][14][15] to develop systems that work without the use of rigid frames and offer interactive, image-guided surgery in (near) real time, so-called frameless stereotaxy. These systems correlate physical space with image space (registration) in different ways.…”

mentioning

confidence: 99%

Application Accuracy of Automatic Registration in Frameless Stereotaxy

Rachinger

Keller

Ganslandt

et al. 2006

Stereotact Funct Neurosurg

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Objective: We compared the application accuracy of an infrared-based neuronavigation system when used with a novel automatic registration with its application accuracy when standard fiducial-based registration is performed. Methods: The automatic referencing tool is based on markers that are integrated in the headrest holder we routinely use in our intraoperative magnetic resonance imaging (MRI) setting and can be detected by the navigation software automatically. For navigation targeting we used a Plexiglas phantom with 32 notched rods of different heights. The phantom was fixed in the head holder and multiple optimized gradient echo slices containing the clamp-integrated markers were acquired. After that we measured a T₁ MPRAGE sequence with a slice thickness of 1.0 mm for navigation. The deepest points of the surface of the rods were defined as target points in image space. In three measurement series we referenced the phantom once with 4, once with 7 fiducials and twice automatically. In one series we performed only one automatic registration. The localization error was measured 3 times per rod and registration. Results: The median localization errors for standard registration with 7 fiducials were between 1.2 and 3.05 mm. With 4 fiducials, medians were in the range from 1.87 to 2.21 mm. For the automatic registration we obtained median localization errors between 0.88 and 2.13 mm. In 6 of the 8 samples that were compared the automatic registration showed an application accuracy that was highly significantly better (p < 0.001 in most cases) than that of fiducial-based standard registration. Conclusion: The application accuracy found for automatic referencing is at least not worse than that for standard registration no matter whether 4 or 7 fiducial markers were used. Therefore, its use in the operating room is feasible. In combination with intraoperative MRI it may become a favorable alternative to standard fiducial-based registration especially when an intraoperative update of navigation data is necessary.

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“…Abweichungen von 0,2-0,5 mm sind mit anderen erhältlichen Systemen nahezu identisch [1][2][3]. Bezieht man die Ungenauigkeit der Bildgebung (CT etwa 0,3-0,4 mm) mit ein [6], so ergibt sich eine Abweichung von etwa 0,8 mm, ein Bereich, der durch die Phantomvorversuche bestätigt werden konnte (Tab.…”

Section: Diskussionunclassified

Dreidimensionale Navigation mit dem EasyGuide<sup>®</sup>-System im Kopf-Hals-Bereich

Heermann¹,

Husstedt

Schwab³

et al. 2000

Otorhinolaryngol Nova

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Fragestellung: Die Verbreitung der minimal invasiven Operationstechniken hat zu neuen chirurgischen Herausforderungen geführt. Insbesondere bei veränderter Anatomie und fehlenden anatomischen Landmarken kann die Orientierung auch für den erfahrenen Chirurgen schwierig sein. Hier haben die intraoperativen Navigationssysteme in den letzten Jahren neue Möglichkeiten eröffnet. Methode/Patienten: Das Navigationssystem EasyGuide^® Neuro (Philips Medizinische Systeme, Best, Niederlande) basiert auf einem dreidimensionalen optoelektronischen Messsystem. Infrarotemittierende Dioden an verschiedenen Pointerinstrumenten sowie der Patientenkopfhalterung werden durch ein Kamerasystem erfasst. Mittels weiterer mathematischer Transformation wird die Position der Instrumente in Bezug zum Patienten berechnet und mit den präoperativ gewonnenen radiologischen Datensätzen korreliert. Durch Studien an verschiedenen Phantomen wurden zunächst die technische Genauigkeit und die Grenzen der optischen Detektion evaluiert. Dann erfolgte bei 38 Patienten der operative Eingriff im Bereich der vorderen und seitlichen Schädelbasis mit Unterstützung des Navigationssystems. Hierbei wurden klinische Genauigkeit, Praktikabilität, Vorteile und Probleme des Systems untersucht. Ergebnisse: Am Phantom bot das System eine Abweichung von unter 1 mm. Im klinischen Einsatz konnte nur mit Kopffixierung und knochenverankerten Referenzmarkern eine Genauigkeit von etwa 1,5 mm erreicht werden. Bei Hautklebereferenzmarkern und flexibler Kopflagerung waren aufgrund der unzuverlässigen Kopfnachführung Abweichungen von bis zu 28 mm möglich. Die präoperative Vorbereitungszeit betrug 20–30 min, je nach Aufwand der Operationsplanung. Schlussfolgerungen: Das intraoperative Orientierungssystem stellt insbesondere bei untypischen anatomischen Verhältnissen eine deutliche Orientierungshilfe dar. HNO-spezifische Veränderungen sind jedoch notwendig, um den routinemässigen Einsatz im Bereich der Nasennebenhöhlenchirurgie zu gewährleisten.

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A Computer-Assisted Device for the Intraoperative CT-Correlated Localization of Brain Tumors

Cited by 66 publications

References 13 publications

The Computer-Assisted Localizer, a Navigational Help in Microneurosurgery

The Computer-Assisted Localizer, a Navigational Help in Microneurosurgery

Application Accuracy of Automatic Registration in Frameless Stereotaxy

Dreidimensionale Navigation mit dem EasyGuide<sup>®</sup>-System im Kopf-Hals-Bereich

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