Evaluation of Intraoperative Brain Shift Using an Ultrasound-Linked Navigation System for Brain Tumor Surgery
Evaluation of Intraoperative Brain Shift Using an Ultrasound-Linked Navigation System for Brain Tumor Surgery
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DOI：
10.2176/nmc.50.291
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发表时间：
2010-04-01
影响因子：
1.9
通讯作者：
Ohnishi, Takanori
中科院分区：
文献类型：
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作者：
Ohue, Shiro;Kumon, Yoshiaki;Ohnishi, Takanori
使用导航系统的图像引导神经外科手术是提高脑肿瘤手术准确性的重要工具。然而，手术中的大脑转移仍然存在问题。本研究评估了一种新的超声导航系统在颅内肿瘤患者脑肿瘤手术中的应用。该导航系统由StealthStation(TM)导航系统、SonoNav(TM)系统和标准US扫描仪组成。该系统确定US图像的方向，并重新格式化来自术前计算机断层扫描(CT)或磁共振(MR)成像的图像以匹配US图像。该系统在术中多次用于测量脑移位，并将结果用于指导肿瘤切除。US链接导航提供了有关脑部移位和手术中肿瘤切除范围的信息。在所有患者中，无需使用术中CT或MR成像，即可轻松实现脑移位的评估。在手术的所有阶段都可以获得有关患者真实解剖结构的准确信息。从切除前到切除后，脑移位的幅度逐渐增大，并取决于颅骨结构的类型。将超声扫描仪与导航系统相结合，可以对术中和术前的US图像进行比较，从而改善对US图像的解释。该系统还通过便于检测残留的肿瘤组织来提高肿瘤切除率。这种与美国相连的导航系统提供了有关大脑转移的信息，并提高了图像引导手术的准确性和实用性。
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.