• World Neurosurg · Aug 2022

    Intraoperative integration of multimodal imaging to improve neuronavigation: a technical note.

    • Edoardo Mazzucchi, Giuseppe La Rocca, Patrick Hiepe, Fabrizio Pignotti, Gianluca Galieri, Domenico Policicchio, Riccardo Boccaletti, Pierluigi Rinaldi, Simona Gaudino, Tamara Ius, and Giovanni Sabatino.
    • Unit of Neurosurgery, Mater Olbia Hospital, Olbia, Italy; Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy. Electronic address: edoardo.mazzucchi@gmail.com.
    • World Neurosurg. 2022 Aug 1; 164: 330-340.

    BackgroundBrain shift may cause significant error in neuronavigation, leading the surgeon to possible mistakes. Intraoperative magnetic resonance imaging (MRI) is the most reliable technique in brain tumor surgery. Unfortunately, it is highly expensive and time consuming and, at the moment, it is available only in few neurosurgical centers.MethodsIn this case series the surgical workflow for brain tumor surgery is described where neuronavigation of preoperative MRI, intraoperative computed tomography (CT) scan, and ultrasound (US) as well as rigid and elastic image fusion between preoperative MRI and intraoperative US and CT, respectively, was applied to 4 brain tumor patients in order to compensate for surgically induced brain shift by using a commercially available software (Elements Image Fusion 4.0 with Virtual iMRI Cranial; Brainlab AG, München, Germany).ResultsFour illustrative cases demonstrated successful integration of different components of the described intraoperative surgical workflow. The data indicate that intraoperative navigation update is feasible by applying intraoperative 3-dimensional US and CT scanning as well as rigid and elastic image fusion applied depending on the degree of observed brain shift.ConclusionsIntegration of multiple intraoperative imaging techniques combined with rigid and elastic image fusion of preoperative MRI may reduce the risk of incorrect neuronavigation during brain tumor resection. Further studies are needed to confirm the present findings in a larger population.Copyright © 2022 Elsevier Inc. All rights reserved.

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