Image-Guided Neurosurgery

Miner, Robert

doi:10.1016/j.jmir.2017.06.005

Cited by 45 publications

(30 citation statements)

References 54 publications

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“…These techniques play an important role in surgical planning as they help determine the best location to make an incision, the optimal path to the targeted anatomical area and what critical structures to avoid. Such an approach, however, requires intraoperative mapping of the preoperative images onto the surgical field . Neurosurgeons lack intraoperative or real‐time feedback and ultimately rely on subjective evaluation of brain tissues (visual inspection or texture assessment) to distinguish between clinically relevant conditions (eg, solid brain tumor and infiltrative edge, radiation‐induced necrosis and normal brain), which can lead to a suboptimal outcome of the surgical therapy.…”

Section: Introductionmentioning

confidence: 99%

Real‐time augmented reality for delineation of surgical margins during neurosurgery using autofluorescence lifetime contrast

Alfonso-García

Bec

Weaver

et al. 2019

Journal of Biophotonics

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Current clinical brain imaging techniques used for surgical planning of tumor resection lack intraoperative and real‐time feedback; hence surgeons ultimately rely on subjective evaluation to identify tumor areas and margins. We report a fluorescence lifetime imaging (FLIm) instrument (excitation: 355 nm; emission spectral bands: 390/40 nm, 470/28 nm, 542/50 nm and 629/53 nm) that integrates with surgical microscopes to provide real‐time intraoperative augmentation of the surgical field of view with fluorescent derived parameters encoding diagnostic information. We show the functionality and safety features of this instrument during neurosurgical procedures in patients undergoing craniotomy for the resection of brain tumors and/or tissue with radiation damage. We demonstrate in three case studies the ability of this instrument to resolve distinct tissue types and pathology including cortex, white matter, tumor and radiation‐induced necrosis. In particular, two patients with effects of radiation‐induced necrosis exhibited longer fluorescence lifetimes and increased optical redox ratio on the necrotic tissue with respect to non‐affected cortex, and an oligodendroglioma resected from a third patient reported shorter fluorescence lifetime and a decrease in optical redox ratio than the surrounding white matter. These results encourage the use of FLIm as a label‐free and non‐invasive intraoperative tool for neurosurgical guidance.

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Section: Introductionmentioning

confidence: 99%

Real‐time augmented reality for delineation of surgical margins during neurosurgery using autofluorescence lifetime contrast

Alfonso-García

Bec

Weaver

et al. 2019

Journal of Biophotonics

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“…Image-guided technology was first developed in neurosurgery and used stereotactic frames to establish a coordinate system and stabilize the head for brain surgery 1 , 57 , including laser ablation, tumor resection, deep brain stimulation (DBS), biopsy, aspiration, and microsurgery, etc 59 – 61 . The disadvantage of stereotaxy is that it is difficult to reach millimeter-level positional accuracy 62 .…”

Section: Discussionmentioning

confidence: 99%

“…Image-guided technology is currently widely used in surgical fields, such as neurosurgery and hepatobiliary surgery, and allows surgeons to determine the boundaries of important anatomical structures and surgical paths 1 , 2 . Surgical robotic systems have the advantages of good tremor filtration, mechanical repeatability, and high stability, and can compensate for the physiological disadvantages of humans, and have consequently gained attention in the past 2 decades 3 .…”

Section: Introductionmentioning

confidence: 99%

Image-guided cochlear access by non-invasive registration: a cadaveric feasibility study

Wang

Liu

et al. 2020

Sci Rep

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Image-guided cochlear implant surgery is expected to reduce volume of mastoidectomy, accelerate recovery, and improve safety. The purpose of this study was to investigate the safety and effectiveness of image-guided cochlear implant surgery by a non-invasive registration method, in a cadaveric study. We developed a visual positioning frame that can utilize the maxillary dentition as a registration tool and completed the tunnels experiment on 5 cadaver specimens (8 cases in total). The accuracy of the entry point and the target point were 0.471 ± 0.276 mm and 0.671 ± 0.268 mm, respectively. The shortest distance from the margin of the tunnel to the facial nerve and the ossicular chain were 0.790 ± 0.709 mm and 1.960 ± 0.630 mm, respectively. All facial nerves, tympanic membranes, and ossicular chains were completely preserved. Using this approach, high accuracy was achieved in this preliminary study, suggesting that the non-invasive registration method can meet the accuracy requirements for cochlear implant surgery. Based on the above accuracy, we speculate that our method can also be applied to neurosurgery, orbitofacial surgery, lateral skull base surgery, and anterior skull base surgery with satisfactory accuracy.

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“…Navigated image guidance systems (IGS) have been shown to improve outcomes in neurosurgery [11][12][13], and have also been applied to LLR with the aim of enhancing intraoperative orientation and to improve safety [7,[14][15][16]. IGS allow surgeons to view structures, such as tumours and blood vessels, that can be seen on preoperative scans but that are not visible with a laparoscopic camera [16,17].…”

Section: Dmentioning

confidence: 99%

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study

et al. 2020

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Background The laparoscopic approach to liver resection may reduce morbidity and hospital stay. However, uptake has been slow due to concerns about patient safety and oncological radicality. Image guidance systems may improve patient safety by enabling 3D visualisation of critical intra- and extrahepatic structures. Current systems suffer from non-intuitive visualisation and a complicated setup process. A novel image guidance system (SmartLiver), offering augmented reality visualisation and semi-automatic registration has been developed to address these issues. A clinical feasibility study evaluated the performance and usability of SmartLiver with either manual or semi-automatic registration. Methods Intraoperative image guidance data were recorded and analysed in patients undergoing laparoscopic liver resection or cancer staging. Stereoscopic surface reconstruction and iterative closest point matching facilitated semi-automatic registration. The primary endpoint was defined as successful registration as determined by the operating surgeon. Secondary endpoints were system usability as assessed by a surgeon questionnaire and comparison of manual vs. semi-automatic registration accuracy. Since SmartLiver is still in development no attempt was made to evaluate its impact on perioperative outcomes. Results The primary endpoint was achieved in 16 out of 18 patients. Initially semi-automatic registration failed because the IGS could not distinguish the liver surface from surrounding structures. Implementation of a deep learning algorithm enabled the IGS to overcome this issue and facilitate semi-automatic registration. Mean registration accuracy was 10.9 ± 4.2 mm (manual) vs. 13.9 ± 4.4 mm (semi-automatic) (Mean difference − 3 mm; p = 0.158). Surgeon feedback was positive about IGS handling and improved intraoperative orientation but also highlighted the need for a simpler setup process and better integration with laparoscopic ultrasound. Conclusion The technical feasibility of using SmartLiver intraoperatively has been demonstrated. With further improvements semi-automatic registration may enhance user friendliness and workflow of SmartLiver. Manual and semi-automatic registration accuracy were comparable but evaluation on a larger patient cohort is required to confirm these findings.

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Image-Guided Neurosurgery

Cited by 45 publications

References 54 publications

Real‐time augmented reality for delineation of surgical margins during neurosurgery using autofluorescence lifetime contrast

Real‐time augmented reality for delineation of surgical margins during neurosurgery using autofluorescence lifetime contrast

Image-guided cochlear access by non-invasive registration: a cadaveric feasibility study

Comparison of manual and semi-automatic registration in augmented reality image-guided liver surgery: a clinical feasibility study

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