Abstract
The major shortcoming of image-guided navigation systems is the use of presurgically acquired image data, which does not account for intra-operative changes such as brain shift, tissue deformation and tissue removal occurring during the surgical procedure. Intra-operative ultrasound (iUS) is becoming widely used in neurosurgery but they lack orientation and panoramic view. In this article, we describe our procedure for US-based real-time neuro-navigation during surgery. We used fusion imaging between preoperative magnetic resonance imaging (MRI) and iUS for brain lesion removal in 67 patients so far. Surgical planning is based on preoperative MRI only. iUS images obtained during surgery are fused with the preoperative MRI. Surgery is performed under intra-operative US control. Relying on US imaging, it is possible to recalibrate navigated MRI imaging, adjusting distortion due to brain shift and tissue resection, continuously updating the two modalities. Ultrasound imaging provides excellent visualization of targets, their margins and surrounding structures. The use of navigated MRI is helpful in better understanding cerebral ultrasound images, providing orientation and panoramic view. Intraoperative US-guided neuro-navigation adjustments are very accurate and helpful in the event of brain shift. The use of this integrated system allows for a true real-time feedback during surgery.
Sommario
Il principale difetto della neurochirurgia guidata da immagini è il basarsi su immagini acquisite prima dell’intervento, che per ovvie ragioni non possono tenere conto di fenomeni intra-operatori come il brain-shift, la deformazione dei tessuti e l’asportazione di tessuto patologico. L’ecografia intra-operatoria (iUS) sta acquisendo sempre maggior rilevanza in ambito neurochirurgico ma è limitata dalla difficoltosa interpretazione dell’orientamento delle immagini e dalla scarsa panoramicità. In questo articolo descriviamo la nostra tecnica di neuronavigazione real-time basata sull’ecografia intra-operatoria. Fino ad ora abbiamo impiegato la fusione d’immagini tra la risonanza magnetica (MRI) pre-operatoria e l’iUS in 67 pazienti affetti da neoplasie cerebrali. La pianificazione dell’intervento e l’approccio chirurgico è basata sulla (MRI) pre-operatoria mentre l’intervento è guidato dall’iUS. Basandosi sull’iUS è possibile correggere la calibrazione delle immagini (MRI) pre-operatorie correggendo il brain-shift, aggiornando continuamente le due modalità. L’ecografia intra-operatoria permette una eccellente identificazione dei target, dei margini e delle strutture circostanti. L’uso del navigatore basato su (MRI) pre-operatoria è utile nella comprensione delle immagini ecografiche soprattutto per quanto riguarda l’orientazione e la visione panoramica. Le correzione del sistema di neuronavigazione basate sull’iUS sono accurate e utili nel caso di fenomeni intra-operatori come il brain-shift, la deformazione dei tessuti e l’asportazione di tessuto patologico. La neuronavigazione baasata sulla fusione d’immagini tra iUS e (MRI) pre-operatoria permette un vero feeback in real-time durante la chirurgia.
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Acknowledgments
The authors would like to thank Mrs. Caroline King for her kind advice in revising the manuscript and Mr. Luca Lodigiani for his technical support. The research leading to these results has received funding from the European Union Seventh Framework Program. FP7/2007-2013 under Grant agreement n.602923.
Conflict of interest
Francesco Prada, Massimiliano Del Bene, Luca Mattei, Cecilia Casali, Assunta Filippini, Federico Legnani, Antonella Mangraviti, Andrea Saladino, Alessandro Perin, Carla Richetta, Ignazio Vetrano, Alessandro Moiraghi, Marco Saini and Francesco DiMeco have no conflict of interest to disclose.
Informed consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). All patients provided written informed consent to enrollment in the study and to the inclusion in this article of information that could potentially lead to their identification.
Human and animal studies
The study was conducted in accordance with all institutional and national guidelines for the care and use of laboratory animals.
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Prada, F., Del Bene, M., Mattei, L. et al. Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery. J Ultrasound 17, 243–251 (2014). https://doi.org/10.1007/s40477-014-0111-8
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DOI: https://doi.org/10.1007/s40477-014-0111-8