Combined Frameless Stereotactical Biopsy and Intraoperative Cerebral Angiography by 3D-Rotational Fluoroscopy with Intravenous Contrast Administration. A Feasibility Study.

Abstract

Purpose: Mobile 3-dimensional fluoroscopes are available in a number of neurosurgical departments and can be used in combination with simple image post processing to depict cerebral vessels. In preparation of stereotactic surgery, preoperative Computed Tomography (CT) may be required for image fusion. Contrast CT may be of further advantage for image fusion as it regards the vessel anatomy in trajectory planning. Time-consuming in-hospital transports are necessary for this purpose. Mobile 3D-fluoroscopes may be used to generate a CT equal preoperative data set without an in-hospital transport. This study was performed to determine the feasibility and image quality of intraoperative 3-dimensional fluoroscopy with intravenous contrast administration.Methods: 6 patients were included in this feasibility study. Their heads were fixed in a radiolucent Mayfield clamp. A rotational fluoroscopy scan was performed with 50 mL iodine contrast agent. The image data sets were merged with the existing MRI images at a planning station and visually evaluated by two observer. The operation times were compared between the frame-based and frameless systems (“skin-to-skin” and “OR entry to exit”)Results: No adverse effects were observed. The entire procedure from fluoroscope positioning to the transfer to the planning station took 5 to 6 minutes with an image acquisition time of 24 seconds. In 5 of 6 cases, the fused imaging was able to reproduce the vascular anatomy accurately and in good quality. Both time end-points were significantly shorter compared to frame-based interventions.Conclusion: The images could easily be transferred to the planning and navigation system and were successfully merged with the MRI data set. The procedure can be completely integrated into the surgical workflow. Preoperative CT imaging or transport under anaesthesia may even be replaced by this technique in the future. Furthermore, hemorrhages can be successfully visualized intraoperatively and might prevent time delays in emergencies.