Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging
Quantification of, visualization of, and compensation for brain shift using intraoperative magnetic resonance imaging
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DOI：
10.1097/00006123-200011000-00008
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发表时间：
2000-11-01
期刊：
影响因子：
4.8
通讯作者：
Fahlbusch, R
中科院分区：
文献类型：
--
作者：
Nimsky, C;Ganslandt, O;Fahlbusch, R
目的：现代神经导航系统在正在进行的外科手术过程中缺乏空间精度，因为大脑变形（称为脑移位）不断增加。术中磁共振成像用于对这种现象进行定量分析和可视化。方法：对于总共 64 名患者，我们使用位于手术室的 0.2-T 开放式配置磁共振成像扫描仪进行术前和术中成像。使用严格的配准方法对三维成像数据进行对齐。测量脑表面、肿瘤深部边缘和中线结构的最大位移。使用分屏或叠加技术在二维图像平面中观察大脑移位，并计算三维、颜色编码、基于可变形表面的数据。在选定的病例中，术中图像被传输到神经导航系统，以补偿脑移位的影响。 结果：结果表明，脑移位存在很大的变异性，66%的病例中，皮质移位范围高达 24 毫米，深部肿瘤边缘超过 3 毫米。脑移位受到组织特征、术中患者体位、脑室系统开放、开颅手术尺寸和切除体积的影响。术中神经导航更新（n = 14）补偿了大脑移位，从而实现了高精度的可靠导航。结论：如果没有大脑移位补偿，神经导航系统在手术过程的关键步骤（例如，深部肿瘤边缘的识别）中就不能被信任。术中成像不仅可以评估和补偿大脑移位，还可以评估试图描述和补偿大脑移位的数学模型的质量。
OBJECTIVE: Modern neuronavigation systems lack spatial accuracy during ongoing surgical procedures because of increasing brain deformation, known as brain shift. Intraoperative magnetic resonance imaging was used for quantitative analysis and visualization of this phenomenon.METHODS: For a total of 64 patients, we used a 0.2-T, open-configuration, magnetic resonance imaging scanner, located in an operating theater, for pre- and intraoperative imaging. The three-dimensional imaging data were aligned using rigid registration methods. The maximal displacements of the brain surface, deep tumor margin, and midline structures were measured. Brain shift was observed in two-dimensional image planes using split-screen or overlay techniques, and three-dimensional, color-coded, deformable surface-based data were computed. In selected cases, intraoperative images were transferred to the neuronavigation system to compensate for the effects of brain shift.RESULTS: The results demonstrated that there was great variability in brain shift, ranging up to 24 mm for cortical displacement and exceeding 3 mm for the deep tumor margin in 66% of all cases. Brain shift was influenced by tissue characteristics, intraoperative patient positioning, opening of the ventricular system, craniotomy size, and resected volume. Intraoperative neuronavigation updating (n = 14) compensated for brain shift, resulting in reliable navigation with high accuracy.CONCLUSION: Without brain shift compensation, neuronavigation systems cannot be trusted at critical steps of the surgical procedure, e.g., identification of the deep tumor margin. Intraoperative imaging allows not only evaluation of and compensation for brain shift but also assessment of the quality of mathematical models that attempt to describe and compensate for brain shift.