Evaluation of Intraoperative Brain Shift Using an Ultrasound-Linked Navigation System for Brain Tumor Surgery

Abstract

Image-guided neurosurgery using navigation systems is an essential tool to increase accuracy in brain tumor surgery. However, brain shift during surgery has remained problematic. The present study evaluated the utility of a new ultrasound (US)-linked navigation system for brain tumor surgery in 64 patients with intracranial tumors. The navigation system consisted of a StealthStation TM navigation system, a SonoNav TM system, and a standard US scanner. This system determines the orientation of the US images and reformats the images from preoperative computed tomography (CT) or magnetic resonance (MR) imaging to match the US images. The system was used intraoperatively to measure brain shift several times, using the results to guide tumor resection. US-linked navigation provided information regarding brain shift, and extent of tumor resection during surgery. Evaluation of brain shift was easily achieved in all patients, without using intraoperative CT or MR imaging. Accurate information regarding the true anatomical configuration of the patient could be obtained in all phases of the operation. Magnitude of brain shift increased progressively from pre-to post-resection and depended on the type of cranial structure. Integration of the US scanner with the navigation system allowed comparisons between the intraoperative US and preoperative images, thus improving interpretation of US images. The system also improved the rate of tumor resection by facilitating the detection of remnant tumor tissue. This US-linked navigation system provides information on brain shift, and improves the accuracy and utility of image-guided surgery.

Wax pile method for glioma surgery utilizing intraoperative magnetic resonance imaging: a technical note

“…Another report described the magnitude of pyramidal tract displacement due to removal of tumor as varying from 0.5 to 8.7 mm on the lesion side and from 0 to 3.6 mm on the normal side [12]. Use of an ultrasound-linked navigation system or updating navigation with intraoperative images have been used to compensate for brain shift [13]. However, all these procedures are cumbersome.…”

“…On the other hand, Ohue et al, reported inserting four silicone catheters at the tumor margin after dural incision. Following insertion of the catheters, ultrasound-linked navigation clearly demonstrated the location of the catheter as a real-time image [13]. However, the problem with this approach is that some tumors show only fair or poor ultrasound images, making residual tumor difficult to evaluate using a synchronized navigation system during surgery.…”

Surgical results of tumor resection using tractography-integrated navigation-guided fence-post catheter techniques and motor-evoked potentials for preservation of motor function in patients with glioblastomas near the pyramidal tracts

“…The navigation system was used in conjunction with an US scanner (Prosound SSD-5500 or alfa 7, ALOKA Co., Tokyo, Japan) for resection of the tumor [39]. After identifying that cortical MEPs could be recorded, brain shift was evaluated using an US image [39], and the accuracy of the fence-post technique was confirmed.…”

“…However, the accuracy of the navigation systems progressively decreases during surgical procedures, a phenomenon described as "brain shift" [39]. Although a re-registration technique using intraoperative magnetic resonance (MR) imaging is useful for resolving the problem of brain shift [42], intraoperative MR imaging techniques are limited by factors such as manpower, cost, and restricted surgical access, and surgeons must stop the operation for repeat intraoperative MR imaging [16,39]. Therefore, fence-post catheter techniques that use navigation systems have been used before beginning the resection of the glioma [16,39].…”

“…Although a re-registration technique using intraoperative magnetic resonance (MR) imaging is useful for resolving the problem of brain shift [42], intraoperative MR imaging techniques are limited by factors such as manpower, cost, and restricted surgical access, and surgeons must stop the operation for repeat intraoperative MR imaging [16,39]. Therefore, fence-post catheter techniques that use navigation systems have been used before beginning the resection of the glioma [16,39]. With the advent of MR imaging, diffusion tensor (DT) imaging-based fiber tracking has recently been used to demonstrate the three-dimensional courses of white matter fibers in patients with brain tumors [3,17].…”