IMAGE GUIDED ENDOVASCULAR EMBOLIZATION OF CRANIAL TUMORS

该提案的目的是开发更快，更安全的方法， 颅内肿瘤术中追踪血管内栓塞治疗 以及在三维（3D）、基于树的 病人的血管系统图 颅内血管的血管内手术是困难的。 在手术中，介入医生将导管穿过 复杂的血管树，仅由x射线血管造影术（血管造影术）引导。 通过导管注入造影剂，突出显示 在投影视图上是脉管树的局部区域。 无3D信息 服务器租用-美国服务租用 相反，临床医生仅使用2D投影、监视器 导管推进几乎是连续的，并经常改变 在尝试可视化3D解剖结构中的视角。该过程 因此耗时长，需要多次血管造影， 在一小时或更长时间的辐射照射下。 这项建议旨在减少程序的难度， 巨大的辐射暴露传递给病人， 介入医生解释每个2D术中血管造影片， 一个3D的环境。 有三个具体目标： a）创建每个患者的血管解剖结构的3D、基于树的图。 该图可以单独从分割的MRA数据创建，或者可以包括 通过重建术前血管造影提供的额外细节 数据转换为3D。 B）创建术前规划环境，其中临床医生 可以从任何一个视图查看脉管系统的基于树的描述 交互选择视角并与目标相关 肿瘤 可以选择并保存一个或多个最佳导管路径 以便以后术中使用。 该程序将在标准硬件上运行 在一个共同的操作系统下， 在现成的电脑上或在家里。 c）为了将3D血管图与每个术中血管造影片配准， 允许介入医生在3D中可视化， 正确子树内的导管。 肿瘤的位置和 预选的最佳导管路径也将以3D示出。 每个 因此，可以在其3D背景内解释2D血管造影照片，从而减少 手术的难度、所需的血管造影次数，以及 患者的辐射暴露和造影剂负荷。 我们纳入了一项前瞻性、随机、对照的临床试验， 我们的方法在减少辐射暴露于 患者和提供更有效的栓塞。 待开发的方法可立即应用于肿瘤 栓塞和化疗输送到身体的任何地方。 他们是 也适用于成千上万的其它血管内手术 每一年都在上演。

The purpose of this proposal is to develop faster, safer methods of endovascular embolization of cranial tumors by intraoperative tracking and display of the catheter within a three-dimensional (3D), tree-based map of the patient's vasculature. Endovascular surgery of the cranial vasculature is difficult. Intraoperatively, the interventionalist threads his catheter through a complex vascular tree, guided only by x-ray angiography (angiography). Puffs of contrast medium are injected through the catheter, highlighting on projection view a local region of a vascular tree. No 3D information is available. Instead, the clinician uses only 2D projections, monitors catheter advancement almost continuously, and frequently changes the angle of view in the attempt to visualize 3D anatomy. The procedure is therefore lengthy, requires multiple angiograms, and commonly results in an hour or more of radiation exposure to the patient. This proposal aims to reduce the difficulty of the procedure and the immense radiation exposure delivered to the patient by allowing the interventionalist to interpret each 2D, intraoperative angiogram within a 3D context. There are 3 specific aims: a) To create a 3D, tree-based map of each patient's vascular anatomy. This map may be created from segmented MRA data alone or may include the additional detail provided by reconstructing preoperative angiographic data into 3D. b) To create a preoperative planning environment, in which the clinician may view a tree-based description of the vasculature from any interactively selected angle of view and in relationship to the target tumor. One or more optimal catheter pathways may be selected and saved for later intraoperative use. The program will run on standard hardware and under a common operating system, allowing study of the vasculature on readily available computers or at home. c) To register the 3D vascular map with each intraoperative angiogram, allowing the interventionalist to visualize, in 3D, t he position of the catheter within the proper subtree. Both the location of the tumor and a preselected optimal catheter pathway will also be shown in 3D. Each 2D angiogram can thus be interpreted within its 3D context, diminishing the difficulty of the procedure, the number of angiograms required, and the patient's radiation exposure and contrast load. We include a prospective, randomized, controlled clinical trial of the efficacy of our methods in both reducing radiation exposure to the patient and in providing more effective embolization. The methods to be developed are immediately applicable to tumor embolization and chemotherapy delivery anywhere in the body. They are also applicable to many thousands of other endovascular procedures preformed each year.