Preoperative Image Updating for Guidance during Brain Tumor Resection

项目摘要 该项目将延续达特茅斯和美敦力之间富有成效的学术-工业合作伙伴关系 通过该技术，达特茅斯的术中图像更新技术已经与Med合并， tronic最先进的S7导航系统，可同时生成和显示更新的MR（uMR）图像 做手术在第二个资助期内，我们将全面验证和前瞻性评估uMR在开颅 通过与术中MR（iMR）的比较，我们还提出了一个新的方向：产生uMR， 指导微创神经外科手术作为可能的低成本，但有效的替代，在孔内MR- 指导 (new微创脑深部电刺激中的图像更新的初步结果表明FEAS- 并建议承诺）。 虽然迄今为止已完成的验证研究使用跟踪触针作为“地面实况”， 令人印象深刻的是，在手术期间的任何给定时间， 特征识别/定位误差被嵌入到TRE（目标配准误差）结果中。因此 我们的延续建议的基石是iMR的验证，这是在达特茅斯的中心， 手术创新（CSI）。由于iMR是在切除术结束时部署的，以调查开放手术中的残留病变， 我们建议，由于患者安全问题，颅骨手术和多次iMR难以证明合理性， 一种新的大型动物胶质瘤模型已经在我们手中成功开发（我们现在可以生长固体 位于颅内不同位置的不同大小和形状的肿瘤） 其中将获取iMR 在切除术期间多次进行uMR确认。这些动物研究也非常适合于 微创病例，因为我们可以确定图像更新要求以指导手术 作为iMR的更高效、更经济的替代品。CSI可以容纳这些实验，作为一个 因此，我们处于一个独特的位置，在同一空间进行动物和人类研究， 导航/成像设备，用于在开颅和微创条件下使用iMR进行uMR确认 条件基于迄今为止的进展和这些考虑，我们提出了技术进步， 将图像更新应用于微创神经外科手术，通过GPU加速图像更新 处理，并将uMR数据添加到外科医生的抬头显示器中;在大型动物胶质瘤开放中进行验证- iMR采集不受限制的颅骨和微创研究，以及类似的人脑 iMR使用受限的肿瘤病例;以及切除术结束时手术准确性的前瞻性评价， 使用术前MR（pMR）导航的手术到uMR也可用的手术。结束时 在拟议的第二个资助期内，我们将拥有一个uMR指导平台，该平台经过全面验证，可用于开放颅骨， 微创手术，并将证明在何种程度上它使神经外科医生， 更频繁地实现更准确的开颅切除术，以及是否足够准确和及时， 相对于孔内MR引导的微创神经外科干预的引导。

PROJECT SUMMARY This project will continue a productive academic-industrial partnership between Dartmouth and Medtronic through which Dartmouth’s intraoperative image updating techniques have already been merged with Med- tronic’s state-of-the-art S7 navigation system to produce and visualize updated MR (uMR) images concurrent with surgery. In a second funding period, we will fully validate and prospectively evaluate uMRs in open-cranial surgery via comparisons with intraoperative MR (iMR). We also propose a new direction: generating uMR to guide minimally invasive neurosurgeries as a possible low-cost, yet effective, alternative to in-bore MR- guidance (new preliminary results of image-updating in minimally-invasive deep brain stimulation indicate feas- ibility and suggest promise). While validation studies completed to date with a tracked stylus as “ground truth” have been impressive, relatively few points are available at any given time during surgery, and tracking and feature identification/localization errors are embedded in the TRE (target registration error) results. Thus, a cornerstone of our continuation proposal is validation with iMR, which is available in Dartmouth’s Center for Surgical Innovation (CSI). Since iMR is deployed at end-of-resection to survey for residual disease in open cranial surgery and multiple iMRs are difficult to justify because of patient safety concerns, we have proposed a new large animal glioma model which has been developed successfully in our hands (we can now grow solid tumors of varying size and shape located in different intra-cranial positions) in which iMR will be acquired multiple times during a resection procedure for uMR validation. These animal studies are also ideally-suited to minimally-invasive cases because we can determine the image-updating requirements to guide the procedure as a more efficient and cost-effective alternative to iMR. CSI can accommodate these experiments, and as a result, we are in a unique position to conduct animal and human studies in the same space with the same navigation/imaging equipment for uMR validation with iMR under both open cranial and minimally invasive conditions. Based on progress to date, and these considerations, we propose technical advances that will apply image-updating to minimally-invasive neurosurgical procedures, accelerate image-updating through GPU processing, and add uMR data into the surgeon’s heads-up display; validation in large animal glioma open- cranial and minimally-invasive studies where iMR acquisitions are not limited, and during similar human brain tumor cases where iMR use is restricted; and prospective evaluation of end-of-resection surgical accuracy of procedures navigated with preoperative MR (pMR) to those where uMR is also available. By the end of the proposed 2nd funding period, we will have an uMR guidance platform that is fully validated for open cranial and minimally-invasive procedures, and will have demonstrated the extent to which it enables neurosurgeons to achieve more accurate open-cranial resections more often, and whether it is sufficiently accurate and timely for guidance of minimally-invasive neurosurgical interventions relative to in-bore MR guidance.