Robotic Digital Subtraction Angiography Systems Within the Hybrid Operating Room

Murayama, Yuichi; Irie, Koreaki; Saguchi, Takayuki; Ishibashi, Toshiyuki; Ebara, Masaki; Nagashima, Hiroyasu; Isoshima, Akira; Arakawa, Hidetoshi; Takao, Hiroyuki; Ohashi, Hiroki; Joki, Tatsuhiro; Kato, Masataka; Tani, Satoshi; Ikeuchi, Satoshi; Abe, Toshiaki

doi:10.1227/neu.0b013e31820b4f1c

Cited by 68 publications

(40 citation statements)

References 7 publications

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“…In a hybrid operative suite containing a fixed C-arm, FDCT can be directly used for frameless neuronavigation because the patient's head is fixed in space throughout the procedure. 6,8,13 Hybrid operative suites, however, require considerable technical and engineering resources, which can be costly. The 3D DSA images have been fused and coregistered with CT or MRI scans for neuronavigation during surgery for complex aneurysms and AVMs.…”

Section: Discussionmentioning

confidence: 99%

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Stidd¹,

Wewel²,

Ghods³

et al. 2014

JNS

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Paralleling the rapid development of neuroimaging technology, the introduction of neuronavigation in the 1980s has revolutionized the surgery of intracranial diseases.2,11 Neuronavigation based on CT or MRI studies has tailored surgical interventions to individual anatomy and pathology, with minimal disruption to the physical and functional architecture of the brain. Vascular anatomy is best appreciated with digital subtraction angiography (DSA), which remains the gold standard for imaging of cerebrovascular pathology. Both CT angiography (CTA) and MR angiography (MRA) have lower detection sensitivity and inferior spatial resolution relative to DSA for aneurysms smaller than 3 mm. 1,19,20 The use of DS angiograms as source images for neuronavigation, however, has been limited because DSA studies typically lack the soft-tissue information necessary to register the radiographic image space to the head in the physical space. Images from DSA typically require fusion with CT or MR images for coregistration.Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration Object. Cerebrovascular lesions can have complicated abnormal anatomy that is not completely characterized by CT or MR angiography. Although 3D rotational angiography provides superior spatial and temporal resolution, catheter angiograms are not easily registered to the patient, limiting the use of these images as a source for neuronavigation. However, 3D digital subtraction angiography (DSA) contains not only vascular anatomy but also facial surface anatomy data. The authors report a novel technique to register 3D DSA images by using only the surface anatomy contained within the data set without having to fuse the DSA image set to other imaging modalities or use fiducial markers.Methods. A cadaver model was first created to assess the accuracy of neuronavigation based on 3D DSA images registered by facial surface anatomy. A 3D DSA scan was obtained of a formalin-fixed cadaver head, with acquisitions of mask and contrast runs. The right common carotid artery was injected prior to the contrast run with a 45% contrast solution diluted with water-soluble red liquid latex. One week later, the head was registered to a neuronavigation system loaded with the 3D DSA images acquired earlier using facial surface anatomy. A right pterional craniotomy was performed and 10 different vascular landmarks were identified and measured for accuracy using the neuronavigation system. Neuronavigation based only on 3D DSA was then used to guide an open clipping procedure for a patient who presented with a ruptured distal lenticulostriate aneurysm.Results. The accuracy of the measurements for the cadaver model was 0.71 ± 0.25 mm (mean ± SE), which is superior to the 1.8-5 mm reported for neuronavigation. The 3D DSA-based navigation-assisted surgery for the distal lenticulostriate aneurysm aided in localization, resulting in a small craniotomy and minimal brain dissection.Conclusions. This is the first example of frameless neu...

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Section: Discussionmentioning

confidence: 99%

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Stidd¹,

Wewel²,

Ghods³

et al. 2014

JNS

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“…To achieve a safe and effective endovascular and surgical environment, we have established a new concept: the hybrid endovascular OR for the treatment of neurovascular diseases 9 10. Becoming more popular in modern neurosurgery, this type of hybrid OR accommodates the innovations of conventional neurosurgery with those of the widely used minimally invasive endovascular neurosurgery.…”

Section: Introductionmentioning

confidence: 99%

Combined surgical and endovascular treatment of complex cerebrovascular diseases in the hybrid operating room

Murayama

Arakawa

Ishibashi

et al. 2012

J NeuroIntervent Surg

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“…Murayama and Irie et al [4] recently reported further developments on their DynaCT based intra-operative imaging suite. They incorporated a robotic multiaxis C-arm for DSA to a surgical operating room table.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of poorly visualised and complex cerebrovascular lesions using pre-operative angiographic data as angiographic DynaCT datasets for frameless stereotactic navigation

et al. 2012

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Robotic Digital Subtraction Angiography Systems Within the Hybrid Operating Room

Abstract: This newly developed robotic DSA system provides safe and precise treatment in the fields of endovascular treatment and neurosurgery.

Cited by 68 publications

References 7 publications

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Frameless neuronavigation based only on 3D digital subtraction angiography using surface-based facial registration

Combined surgical and endovascular treatment of complex cerebrovascular diseases in the hybrid operating room

Surgical treatment of poorly visualised and complex cerebrovascular lesions using pre-operative angiographic data as angiographic DynaCT datasets for frameless stereotactic navigation

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