Intraoperative Image Guidance in Neurosurgery: Development, Current Indications, and Future Trends

Abstract

Introduction. As minimally invasive surgery becomes the standard of care in neurosurgery, it is imperative that surgeons become skilled in the use of image-guided techniques. The development of image-guided neurosurgery represents a substantial improvement in the microsurgical treatment of tumors, vascular malformations, and other intracranial lesions. Objective. There have been numerous advances in neurosurgery which have aided the neurosurgeon to achieve accurate removal of pathological tissue with minimal disruption of surrounding healthy neuronal matter including the development of microsurgical, endoscopic, and endovascular techniques. Neuronavigation systems and intraoperative imaging should improve success in cranial neurosurgery. Additional functional imaging modalities such as PET, SPECT, DTI (for fiber tracking), and fMRI can now be used in order to reduce neurological deficits resulting from surgery; however the positive long-term effect remains questionable for many indications. Method. PubMed database search using the search term “image guided neurosurgery.” More than 1400 articles were published during the last 25 years. The abstracts were scanned for prospective comparative trials. Results and Conclusion. 14 comparative trials are published. To date significant data amount show advantages in intraoperative accuracy influencing the perioperative morbidity and long-term outcome only for cerebral glioma surgery.

Android application for determining surgical variables in brain-tumor resection procedures

“…1 In a recent review, Schulz et al 2 considered 1400 papers over the previous 25 years and found 14 comparative studies for their analysis. The authors came to the conclusions that conventional IGNS reduces tumor burden, improves survival, reduces neurological deterioration, and does not have significant impact on the operating room (OR).…”

“…The general finding was that accounting for soft tissue changes is desirable and that it improved survival times over conventional IGNS; however, the use of iMR systems has a considerable impact to the OR, surgical times, and expense. 2 Based on Schulz et al's review, image guidance and the compensation for soft tissue changes, also known as "brain shift," are highly desirable and cost-effective but accurate solutions would be of particular importance.…”

“…For example, in Ref. 16, the framework described requires (1) patient brain segmentation as well as subsurface structures, such as dural septa and tumors, (2) preoperative planning data acquisition, and (3) precomputations based on planning data. Other approaches are similar in needing preoperative segmentation and mesh building as well, e.g., Refs.…”

A method for the assessment of time-varying brain shift during navigated epilepsy surgery

“…Registration between the image space and the surgical space is the preliminary step, and it can be accomplished by identifying corresponding landmarks or surfaces [1,2]. Image guidance can support the surgeon during many types of surgery, such as resections aimed at the removal of brain tumors or of epileptogenic zones.…”

Multimodal neuronavigation in preoperative planning and intraoperative orientation in brain tumors surgery

“…Использование трехмерных моделей на этапах предоперационного планирования позволяет провести визуализацию и определить соотношение нормальных анатомических структур и патологических очагов, установить ана-томические ориентиры для интраоперационного со-поставления и ориентирования, выбрать адекватный хирургический доступ, оптимизировать методику удаления опухоли. Построение трехмерных моделей проводят путем сегментации с последующей реконструк-цией опухоли и ее полостных компонен-тов, коры большого мозга с указанием участков функциональной активности, подкорковых проводящих путей, магист-ральных кровеносных сосудов и системы желудочков мозга [24][25][26].Данные дополнительных серий МРТ (DWI, T2-FLAIR) и методов обследова-ния (КТ, ОФЭКТ) позволяют провести более дос товерную сег мен тацию и выделить солидную час ть опу холи, определить кистозный, некротический или геморрагический компонент, ви-зуализировать зону перифокального отека, участки гиперваскуляризации и активной пролиферации опухоли. Воз-действие опухолевого очага на смежные анатомические образования определяют на 3D-моделях в виде сопутствующих изменений окружающих структур ГМ: деформации и сглаживания рельефа коры большого мозга, дислокации и компрессии извилин, транспозиции конвекситальных вен.…”