Quantification of True In Vivo (Application) Accuracy in Cranial Image-guided Surgery: Influence of Mode of Patient Registration

Mascott, Christopher R.; Sol, Jean‐Christophe; Bousquet, Philippe; Lagarrigue, J; Lazorthes, Y.; Lauwers‐Cancès, Valérie

doi:10.1227/01.neu.0000220089.39533.4e

Cited by 70 publications

(78 citation statements)

References 9 publications

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“…Dorward et al [27] found a euclidean error of 4.8 mm in the in vivo arm of their study. Mascott et al [26] report mean localization errors between 3.3 and 5.4 mm. One relatively recent comparative phantom study actually found a smaller euclidean error in a frameless system when a specific planning and targeting protocol was used (probe's eye) [28].…”

Section: Frameless Stereotaxy: a Hypothetical Cohortmentioning

confidence: 99%

“…RMS gives no information regarding the correspondence of those coordinates to the actual location of objects in physical space. This concept was elegantly demonstrated by Mascott et al who found no statistically significant correlation of RMS values with the accuracy of marker placement in a large in vivo study [26]. Studies using phantom models typically measure the mean error of localization, which represents the average magnitude of the distance between the probe and its intended target.…”

Section: Frameless Stereotaxy: a Hypothetical Cohortmentioning

confidence: 99%

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Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Owen

Linskey

2009

J Neurooncol

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Introduction In the modern era of frameless stereotaxis (FL), the role of frame-based (FB) stereotactic needle biopsy is evolving. Methods Retrospective review of prospective database of 106 lesions in 91 consecutive patients undergoing FB stereotactic needle biopsy with a systematic ''geologic core'' technique by a single surgeon. Diagnostic accuracy was calculated comparing biopsy diagnosis with final pathology in 11 patients who underwent subsequent surgical resection. All instances of intra-operative bleeding through the needle were prospectively noted and compared with post-biopsy CT scan. Lesions were classified as risky for FL technique if they were (1) infratentorial or pineal, (2) within 10 mm of the circle of Willis or root of the Sylvian fissure, or (3) within 10 mm of deep cerebral veins. Results Diagnostic yield was 94%. Diagnostic accuracy was 91%. Of 18 lesions involving the corpus callosum, 13 (72.2%) were GBM 2 were anaplastic astrocytoma, and 1 each were found to be anaplastic oligodendroglioma, primary central nervous system lymphoma (PCNSL) and tumescent MS. Of 25 multifocal lesions, malignant primary brain tumor was diagnosed in 17 (68%) (11 GBM, 3 PCNSL, 2 anaplastic ologodendroglioma, and 1 anaplastic astrocytoma). Mortality was 0%. Three patients developed temporary neurologic deficits and one had permanent deficit. Absence of persistent blood through the biopsy needle had a negative predicative value of 98.8% for subsequent neuroimaging blood [5 mm diameter. According to our criteria, 80% of patients would have been candidates for FL biopsy. Conclusions Stereotactic biopsy is an effective, safe and important technique for histologic diagnosis of brain lesions, particularly for multifocal and corpus callosum lesions. Postbiopsy CT can be safely reserved for patients who demonstrate persistent bleeding through the biopsy needle. FB stereotaxy remains an important technique for the 20% with small or deep seated lesions or when it is advantageous to avoid an incision, a burr hole or general anesthesia.

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Section: Frameless Stereotaxy: a Hypothetical Cohortmentioning

confidence: 99%

Section: Frameless Stereotaxy: a Hypothetical Cohortmentioning

confidence: 99%

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Owen

Linskey

2009

J Neurooncol

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“…This method is currently the "gold standard" for image-tophysical rigid registration. [3][4][5] A more unusual alternative is the use of cortical surface landmarks whereby vessel bifurcations identified on the patient's brain and within MR images are used to determine correspondence. 6 While PBR is standard in most of today's ORs, other techniques have also been pursued that use surface contour data to achieve a MRsurface to patient-surface registration.…”

Section: Introductionmentioning

confidence: 99%

Laser range scanning for image‐guided neurosurgery: Investigation of image‐to‐physical space registrations

et al. 2008

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In this article a comprehensive set of registration methods is utilized to provide image-to-physical space registration for image-guided neurosurgery in a clinical study. Central to all methods is the use of textured point clouds as provided by laser range scanning technology. The objective is to perform a systematic comparison of registration methods that include both extracranial ͑skin marker point-based registration ͑PBR͒, and face-based surface registration͒ and intracranial methods ͑fea-ture PBR, cortical vessel-contour registration, a combined geometry/intensity surface registration method, and a constrained form of that method to improve robustness͒. The platform facilitates the selection of discrete soft-tissue landmarks that appear on the patient's intraoperative cortical surface and the preoperative gadolinium-enhanced magnetic resonance ͑MR͒ image volume, i.e., true corresponding novel targets. In an 11 patient study, data were taken to allow statistical comparison among registration methods within the context of registration error. The results indicate that intraoperative face-based surface registration is statistically equivalent to traditional skin marker registration. The four intracranial registration methods were investigated and the results demonstrated a target registration error of 1.6Ϯ 0.5 mm, 1.7Ϯ 0.5 mm, 3.9Ϯ 3.4 mm, and 2.0Ϯ 0.9 mm, for feature PBR, cortical vessel-contour registration, unconstrained geometric/intensity registration, and constrained geometric/intensity registration, respectively. When analyzing the results on a per case basis, the constrained geometric/intensity registration performed best, followed by feature PBR, and finally cortical vessel-contour registration. Interestingly, the best target registration errors are similar to targeting errors reported using bone-implanted markers within the context of rigid targets. The experience in this study as with others is that brain shift can compromise extracranial registration methods from the earliest stages. Based on the results reported here, organ-based approaches to registration would improve this, especially for shallow lesions.

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“…There are two primary issues of concern: (1) the difference between target registration and accuracy at the skull base and (2) the lack of real-time intraoperative feedback. 15,16 The shortcomings of applying traditional neuronavigational systems to the skull base, particularly the temporal bone, have been addressed in the literature. Previous studies have demonstrated that registration error does not necessarily correlate with actual anatomic accuracy or global accuracy at the skull base.…”

Section: Current Neuronavigational Systems and Skull Base Surgerymentioning

confidence: 99%

Real-Time Imaging with the O-Arm for Skull Base Applications: A Cadaveric Feasibility Study

Raza¹,

See²,

Lim³

2012

J Neurol Surg B

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IntroductionThe anatomy of the skull base is extremely dense with critical neurovascular structures.1,2 Approaches to cranial base pathology, benign or malignant, can often place these structures at risk due to inadvertent injury. In performing these complicated approaches, intraoperative identification of anatomic landmarks often guides bony resection; however, these landmarks can be distorted by the pathology of interest. This need for anatomic mapping highlights the value of neuronavigation in supplementing a surgeon's anatomic understanding. Although image-guidance systems and intraoperative navigation have improved surgical speed and safety, they are mostly based on preoperative imaging. In addition, these images are obtained prior to positioning. As a result, pinning and positioning the patients will often distort the skin and overlying fiducials and thereby decrease the accuracy of the image guidance systems. AbstractIntroduction Although intraoperative imaging/navigation has established its critical role in neurosurgery, its role in cranial base surgery is currently limited. Due to issues such as poor bony resolution and accuracy, surgeons have to rely on anatomic landmarks that can be distorted by pathology when drilling out critical structures. Though originally developed for spinal application, we hypothesized that the O-Arm could address the above issues for use in cranial base procedures. Methods A cadaveric study was performed in which heads underwent a preprocedure scan via the O-Arm, a fluoroscopic device capable of providing three-dimensional images through the use of cone-beam technology. Preprocedure scans were taken and then registered to a Stealth S7 machine (Medtronic, Inc., Minneapolis, MN, USA). Key cranial base landmarks were identified on these scans and then subsequently identified under direct visualization after (1) endoscopic endonasal dissection and (2) a middle fossa approach. We then quantified the difference in distance between the preplanned and identified structure during surgery. This difference was considered the error. Results For anterior cranial fossa structures, the mean error was 0.25 mm (anterior septum), 0.27 mm (left septum), and 0.32 mm (right septum). For middle fossa structures, the errors were: 0.11 mm (foramen spinosum), 0.44 mm (foramen rotundum), and 0.21 mm (foramen ovale). Conclusion Based on this preliminary cadaveric study, we feel the O-Arm can provide the necessary imaging resolution at the skull base to be employed for intraoperative navigation during cranial base approaches (open and endoscopic). This study warrants further investigation into its clinical use in patients undergoing similar surgical procedures.

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Quantification of True In Vivo (Application) Accuracy in Cranial Image-guided Surgery: Influence of Mode of Patient Registration

Cited by 70 publications

References 9 publications

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Laser range scanning for image‐guided neurosurgery: Investigation of image‐to‐physical space registrations

Real-Time Imaging with the O-Arm for Skull Base Applications: A Cadaveric Feasibility Study

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