Updated Neuroimaging Using Intraoperative Brain Modeling and Sparse Data

Miga, Michael I.; Roberts, David W.; Hartov, Alex; Eisner, Symma D.; Lemery, John M.; Kennedy, Francis E.; Paulsen, Keith D.

doi:10.1159/000029707

Cited by 18 publications

(9 citation statements)

References 11 publications

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“…Despite these dilemmas, multiple brain shift prediction models have been derived and studied. 16,25 Many models demonstrate an almost monotonous unidirectional motion primarily accounting for CSF drainage and gravity, which is not supported by our data. One promising method modifies preoperative imaging with several strategic intraoperative points to increase accuracy.…”

Section: Predictability Of Shiftcontrasting

confidence: 83%

“…Shift is typically initiated by intracranial air entry, which may be due to loss of CSF and/or due to equalization of intracranial and atmospheric pressure. 2,16,17 Other causes of shift specific to stereotactic surgery include the deformation of tissue caused by the tip of a rigid electrode during implantation. Although not tested in our study, several reports suggest ways to reduce brain shift.…”

Section: Prevention Of Shiftmentioning

confidence: 99%

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Brain shift during bur hole–based procedures using interventional MRI

Ivan¹,

Yarlagadda

Saxena

et al. 2014

JNS

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Object. Brain shift during minimally invasive, bur hole-based procedures such as deep brain stimulation (DBS) electrode implantation and stereotactic brain biopsy is not well characterized or understood. We examine shift in various regions of the brain during a novel paradigm of DBS electrode implantation using interventional imaging throughout the procedure with high-field interventional MRI.Methods. Serial MR images were obtained and analyzed using a 1.5-T magnet prior to, during, and after the placement of DBS electrodes via frontal bur holes in 44 procedures. Three-dimensional coordinates in MR space of unique superficial and deep brain structures were recorded, and the magnitude, direction, and rate of shift were calculated. Measurements were recorded to the nearest 0.1 mm.Results. Shift ranged from 0.0 to 10.1 mm throughout all structures in the brain. The greatest shift was seen in the frontal lobe, followed by the temporal and occipital lobes. Shift was also observed in deep structures such as the anterior and posterior commissures and basal ganglia; shift in the pallidum and subthalamic region ipsilateral to the bur hole averaged 0.6 mm, with 9% of patients having over 2 mm of shift in deep brain structures. Small amounts of shift were observed during all procedures; however, the initial degree of shift and its direction were unpredictable.Conclusions. Brain shift is continual and unpredictable and can render traditional stereotactic targeting based on preoperative imaging inaccurate even in deep brain structures such as those used for DBS. This article contains some figures that are displayed in color on line but in black-and-white in the print edition.M. E. Ivan et al. 150J Neurosurg / Volume 121 / July 2014 pressure) or to mechanical force on the brain resulting from the intracranial passage of guidance catheters. Methods Patient Selection and DemographicsA total of 39 patients underwent 47 consecutive operations for implantation of a deep brain stimulator for either Parkinson's disease (PD) or dystonia at the University of California, San Francisco (UCSF) Medical Center. These patients underwent unilateral or bilateral placement of their DBS electrodes via a bur hole procedure. Table 1 shows the patient population, procedure, location, target, and disease process. Three surgeries were excluded from the analysis. One patient was intentionally moved between MRI sequences, invalidating the methodology used to assess brain shift. In 2 additional cases, data were analyzed but the control values for fixed points in the cranium were above our acceptable threshold (> 0.5 mm, see below). Therefore, 44 separate operations were included in this study. Six patients were operated on twice either due to staged unilateral placement of stimulators (5 patients) or replacement of stimulators after infection (1 patient). The average age at the time of surgery was 58 ± 13 years old, and 48% of the patients were female. Fifteen patients had unilateral stimulator placement and 29 had bilateral placement. The target was t...

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Section: Predictability Of Shiftcontrasting

confidence: 83%

Section: Prevention Of Shiftmentioning

confidence: 99%

Brain shift during bur hole–based procedures using interventional MRI

Ivan¹,

Yarlagadda

Saxena

et al. 2014

JNS

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“…This decreased capillary pressure pulls interstitial fluid from the extracellular brain space causing a decrease in tissue volume and is modeled using the term on the right-hand side of Equation 2. Extensive validation studies have been conducted in porcine systems using this model [22, 20, 23, 24]. Miga et al presented work concerned with gravity-induced shift and strategies to simulate retraction and resection [20, 7].…”

Section: Methodsmentioning

confidence: 99%

A Fast and Efficient Method to Compensate for Brain Shift for Tumor Resection Therapies Measured Between Preoperative and Postoperative Tomograms

Dumpuri

Thompson

Cao

et al. 2010

IEEE Trans. Biomed. Eng.

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In this paper, an efficient paradigm is presented to correct for brain shift during tumor resection therapies. For this study, high resolution pre-operative (pre-op) and post-operative (post-op) magnetic resonance images were acquired for 8 in vivo patients, and surface/subsurface shift was identified by manual identification of homologous points between the pre-op and immediate postop tomograms. Cortical surface deformation data was then used to drive an inverse problem framework. The manually identified subsurface deformations served as a comparison towards validation. The proposed framework recaptured 85% of the mean sub-surface shift. This translated to a sub-surface shift error of 0.4mm±0.4mm for a measured shift of 3.1mm±0.6mm. The patient's pre-op tomograms were also deformed volumetrically using displacements predicted by the model. Results presented allow a preliminary evaluation of correction both quantitatively, and visually. While intra-op MR imaging data would be optimal, the extent of shift measured from pre-to postoperative MR was comparable to clinical conditions. This study demonstrates the accuracy of the proposed framework in predicting full volume displacements from sparse shift measurements. It also shows that the proposed framework can be extended and used to update pre-op images on a time scale that is compatible with surgery.

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“…In frame-based stereotaxy, this involves setting up the frame coordinates; in frameless stereotaxy, this involves fiducial registration. Once the operation begins and the dura is opened, loss of cerebrospinal fluid and development of pneumocephalus combine to cause unpredictable and varying degrees of brain shift, even in deep brain structures 6–8 . These stereotactic procedures are therefore inherently susceptible to inaccuracies as a result of errors in registration, errors due to brain shift and/or human errors in technique.…”

mentioning

confidence: 99%

An Optimized System for Interventional Magnetic Resonance Imaging-Guided Stereotactic Surgery

Larson

Starr

Bates³

et al. 2012

Operative Neurosurgery

100

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Background Deep brain stimulation (DBS) electrode placement using interventional MRI has been previously reported using a commercially available skull mounted aiming device (Medtronic Nexframe MR) and native MRI scanner software. This first-generation method has technical limitations that are inherent to the hardware and software used. A novel system (SurgiVision ClearPoint) consisting of an aiming device (SMARTFrame) and software has been developed specifically for iMRI interventions including DBS. Objective A series of phantom and cadaver tests were performed to determine the system’s capability, preliminary accuracy and workflow. Methods 18 experiments using a water phantom were used to determine predictive accuracy of the software. 16 experiments using a gelatin-filled skull phantom were used to determine targeting accuracy of the aiming device. 6 procedures in three cadaver heads were performed to compare workflow and accuracy of ClearPoint with Nexframe MR. Results Software prediction experiments showed an average error of 0.9±0.5 mm in magnitude in pitch and roll (mean pitch error −0.2±0.7 mm, mean roll error +0.2±0.7 mm) and an average error of 0.7±0.3 mm in X-Y translation with a slight anterior (0.5±0.3 mm) and lateral (0.4±0.3mm) bias. Targeting accuracy experiments showed average radial error of 0.5±0.3 mm. Cadaver experiments showed a radial error of 0.2±0.1 mm with the ClearPoint system (average procedure time 88±14 minutes) vs 0.6±0.2 mm with the Nexframe MR (average procedure time 92±12 minutes). Conclusion This novel system provides the submillimetric accuracy required for stereotactic interventions including DBS placement. It also overcomes technical limitations inherent in the first-generation iMRI system.

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Updated Neuroimaging Using Intraoperative Brain Modeling and Sparse Data

Cited by 18 publications

References 11 publications

Brain shift during bur hole–based procedures using interventional MRI

Brain shift during bur hole–based procedures using interventional MRI

A Fast and Efficient Method to Compensate for Brain Shift for Tumor Resection Therapies Measured Between Preoperative and Postoperative Tomograms

An Optimized System for Interventional Magnetic Resonance Imaging-Guided Stereotactic Surgery

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