The optical digitizer is an accurate frameless device that offers clinical benefits. These include precise surgical resection, decreased hospitalization time, and accurate tissue diagnosis.
Although endovascular treatment of aneurysms protects most patients from aneurysm rupture, this case illustrates the fact that coiling, followed by proximal occlusion, might fail to alleviate symptoms related to mass effect. Our experience in this case suggests that early surgical decompression may be indicated for patients presenting with progressive visual deterioration.
We investigated whether head CT images captured using a mobile phone would be of sufficient quality for neurosurgeons at a level 1 trauma centre to make decisions about whether to transfer patients from referring hospitals. All patients who had been transferred from outside facilities with reported intracranial pathology during 2008 were identified. Two emergency medicine physicians selected 1-3 images from the hospital archive that best represented the pathology described by the radiologist and the medical record. The images were photographed in a darkened room using a smart phone. The mobile phone images and clinical history were reviewed by two neurosurgeons independently. The neurosurgeons rated the adequacy and quality of the images, and indicated whether the images would have changed their transfer decision. Based on clinical data alone, neurosurgeon A would have transferred 64 (73%) patients and neurosurgeon B 39 (44%). After images were provided, A would have transferred 67 (76%) and B would have transferred 49 (56%). The availability of the images significantly altered the transfer decision by A in 25 cases (28%) (P = 0.024) and by B in 28 cases (32%) (P < 0.001). The level of agreement between the two neurosurgeons significantly increased from 53% (kappa = 0.11) to 75% (kappa = 0.47) (P < 0.001). Mobile-phone images of CT scans appear to provide adequate images for triaging patients and helping with transfer decisions of neurosurgical cases.
Computer-assisted frameless neurosurgery bases its accuracy and reliability on registration. The aim of this prospective study was to compare the clinical accuracy of different registration techniques used for computer-assisted frameless neurosurgery. Ninety-eight registrations in 44 patients were used to compare the clinical accuracy of self-adhesive marker (MR) and facial landmark (FR) registrations used alone or in conjunction with surface-fit registration (MR/SR and FR/SR, respectively) for cranial neurosurgery. The computer estimated error (CEE) of each registration was compared to the real error (RE). This was obtained by holding the frameless pointer at the center of three different markers and measuring the distance from the real-time representation on the computer three-planar images to the center of the marker on the screen. The most accurate registration was obtained using MR; the RE of MR was 1.6 +/- 0.1 mm compared to 3.4 +/- 0.4 mm for FR. Although the smallest CEE error was obtained using MR/SR, this was not sustained by the RE. Furthermore, the RE of FR/SR was significantly larger than the CEE (Student t test, p <.001). This study corroborates previous results showing that, in the clinical setting, self-adhesive marker registration is more accurate than facial landmark registration. Furthermore, although surface-fit registration can be used in conjunction with self-adhesive marker registration, this does not improve the degree of real accuracy for cranial registration.
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