Postimaging brain distortion: magnitude, correlates, and impact on neuronavigation

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Object. This prospective study was conducted to quantify brain shifts during open cranial surgery, to determine correlations between these shifts and image characteristics, and to assess the impact of postimaging brain distortion on neuronavigation.

Methods. During 48 operations, movements of the cortex on opening, the deep tumor margin, and the cortex at completion were measured relative to the preoperative image position with the aid of an image-guidance system. Bone surface offset was used to assess system accuracy and correct for registration errors. Preoperative images were examined for the presence of edema and to determine tumor volume, midline shift, and depth of the lesion below the skin surface. Results were analyzed for all cases together and separately for four tumor groups: 13 meningiomas, 18 gliomas, 11 nonglial intraaxial lesions, and six skull base lesions.

For all 48 cases the mean shift of the cortex after dural opening was 4.6 mm, shift of the deep tumor margin was 5.1 mm, and shift of the cortex at completion was 6.7 mm. Each tumor group displayed unique patterns of shift, with significantly greater shift at depth in meningiomas than gliomas (p = 0.007) and significantly less shift in skull base cases than other groups (p = 0.003). Whereas the preoperative image characteristics correlating with shift of the cortex on opening were the presence of edema and depth of the tumor below skin surface, predictors of shift at depth were the presence of edema, the lesion volume, midline shift, and magnitude of shift of the cortex on opening.

Conclusions. This study quantified intraoperative brain distortion, determined the different behavior of tumors in four pathological groups, and identified preoperative predictors of shift with which the reliability of neuronavigation may be estimated.

Article Information

Address reprint requests to: Neil L. Dorward, F.R.C.S., Gough-Cooper Department of Neurological Surgery, National Hospital For Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Photograph of the neuronavigation system's screen demonstrating the method of distortion measurement. The distance between the pointer tip, which is placed on the bone surface in this example, and the bone surface in the preoperative images is determined with the caliper tool (the distance has been exaggerated for clarity).

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    Bar graphs displaying preoperative MR imaging characteristics according to tumor group. The occurrence of reactive edema is given as the percentage of tumors with edema present.

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    Bar graph of mean brain shift according to tumor group, demonstrating the different patterns of shift revealed by the study.

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    Bar graphs displaying the direction of brain shift on opening, at depth, and at completion (closure) for each tumor group.

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    Scatterplot and linear regression illustrating the correlation between shift of the cortex on opening and shift of the deepest tumor margin (r = 0.5, p = 0.006).

References

  • 1.

    Barnett GHKormos DWSteiner CPet al: Use of a frameless, armless stereotactic wand for brain tumor localization with two-dimensional and three-dimensional neuroimaging. Neurosurgery 33:6746781993Barnett GH Kormos DW Steiner CP et al: Use of a frameless armless stereotactic wand for brain tumor localization with two-dimensional and three-dimensional neuroimaging. Neurosurgery 33:674–678 1993

    • Search Google Scholar
    • Export Citation
  • 2.

    Barnett GHSteiner CPWeisenberger J: Intracranial meningioma resection using frameless stereotaxy. J Image Guided Surg 1:46521995Barnett GH Steiner CP Weisenberger J: Intracranial meningioma resection using frameless stereotaxy. J Image Guided Surg 1:46–52 1995

    • Search Google Scholar
    • Export Citation
  • 3.

    Bucholz RSturm CHenderson J: Detection of brain shift with an image guided ultrasound device. Acta Neurochir 138:6271996 (Abstract)Bucholz R Sturm C Henderson J: Detection of brain shift with an image guided ultrasound device. Acta Neurochir 138:627 1996 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 4.

    Bucholz RDSmith KR: A comparison of sonic digitizers versus light emitting diode-based localization in Maciunas RJ (ed): Interactive Image-Guided Neurosurgery. Park Ridge, Ill: American Association of Neurological Surgeons1993 pp 179200Bucholz RD Smith KR: A comparison of sonic digitizers versus light emitting diode-based localization in Maciunas RJ (ed): Interactive Image-Guided Neurosurgery. Park Ridge Ill: American Association of Neurological Surgeons 1993 pp 179–200

    • Search Google Scholar
    • Export Citation
  • 5.

    Buurman JGerritsen FA: European Applications in Surgical Interventions (EASI) in Lemke HUVannier MWInamura Ket al (eds): CAR ‘96. Computer Assisted Radiology. Amsterdam: Elsevier1996 pp 677685Buurman J Gerritsen FA: European Applications in Surgical Interventions (EASI) in Lemke HU Vannier MW Inamura K et al (eds): CAR ‘96. Computer Assisted Radiology. Amsterdam: Elsevier 1996 pp 677–685

    • Search Google Scholar
    • Export Citation
  • 6.

    Dorward NL: Neuronavigation—the surgeon's sextant. Br J Neurosurg 11:1011031997Dorward NL: Neuronavigation—the surgeon's sextant. Br J Neurosurg 11:101–103 1997

    • Search Google Scholar
    • Export Citation
  • 7.

    Drake JMRutka JTHoffman HJ: ISG viewing wand system. Neurosurgery 34:109410971994Drake JM Rutka JT Hoffman HJ: ISG viewing wand system. Neurosurgery 34:1094–1097 1994

    • Search Google Scholar
    • Export Citation
  • 8.

    Fuchs MWischmann HANeumann Aet al: Accuracy analysis for image-guided neurosurgery using fiducial skin markers, 3D CT imaging and an optical localizer system in Lemke HUVannier MWInamura Ket al (eds): CAR ‘96. Computer Assisted Radiology. Amsterdam: Elsevier1996 pp 770775Fuchs M Wischmann HA Neumann A et al: Accuracy analysis for image-guided neurosurgery using fiducial skin markers 3D CT imaging and an optical localizer system in Lemke HU Vannier MW Inamura K et al (eds): CAR ‘96. Computer Assisted Radiology. Amsterdam: Elsevier 1996 pp 770–775

    • Search Google Scholar
    • Export Citation
  • 9.

    Golfinos JGFitzpatrick BCSmith LRet al: Clinical use of a frameless stereotactic arm: results of 325 cases. J Neurosurg 83:1972051995Golfinos JG Fitzpatrick BC Smith LR et al: Clinical use of a frameless stereotactic arm: results of 325 cases. J Neurosurg 83:197–205 1995

    • Search Google Scholar
    • Export Citation
  • 10.

    Henderson JMEichholz KMBucholz RD: Decreased length of stay and hospital costs in patients undergoing image-guided craniotomies. J Neurosurg 86:367A1997 (Abstract)Henderson JM Eichholz KM Bucholz RD: Decreased length of stay and hospital costs in patients undergoing image-guided craniotomies. J Neurosurg 86:367A 1997 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 11.

    Kelly PJ: Stereotactic excision of brain tumours in Thomas DGT (ed): Stereotactic and Image Directed Surgery of Brain Tumours. Edinburgh: Churchill Livingstone1993 pp 89109Kelly PJ: Stereotactic excision of brain tumours in Thomas DGT (ed): Stereotactic and Image Directed Surgery of Brain Tumours. Edinburgh: Churchill Livingstone 1993 pp 89–109

    • Search Google Scholar
    • Export Citation
  • 12.

    Kelly PJKall BAGoerss SJ: Results of computed tomography-based computer-assisted stereotactic resection of metastatic intracranial tumors. Neurosurgery 22:7171988Kelly PJ Kall BA Goerss SJ: Results of computed tomography-based computer-assisted stereotactic resection of metastatic intracranial tumors. Neurosurgery 22:7–17 1988

    • Search Google Scholar
    • Export Citation
  • 13.

    Koivukangas JLouhisalmi YAlakuijala Jet al: Ultrasound-controlled neuronavigator-guided brain surgery. J Neurosurg 79:36421993Koivukangas J Louhisalmi Y Alakuijala J et al: Ultrasound-controlled neuronavigator-guided brain surgery. J Neurosurg 79:36–42 1993

    • Search Google Scholar
    • Export Citation
  • 14.

    Kwoh YSHou JJonckheere EAet al: A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Trans Biomed Eng 35:1531601988Kwoh YS Hou J Jonckheere EA et al: et al:A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Trans Biomed Eng 35:153–160 1988

    • Search Google Scholar
    • Export Citation
  • 15.

    Lunsford LDKondziolka DBissonette DJ: Intraoperative imaging of the brain. Stereotact Funct Neurosurg 66:58641996Lunsford LD Kondziolka D Bissonette DJ: Intraoperative imaging of the brain. Stereotact Funct Neurosurg 66:58–64 1996

    • Search Google Scholar
    • Export Citation
  • 16.

    Maciunas RJ (ed): Interactive Image-Guided Neurosurgery. Park Ridge, Ill: American Association of Neurological Surgeons1993Maciunas RJ (ed): Interactive Image-Guided Neurosurgery. Park Ridge Ill: American Association of Neurological Surgeons 1993

    • Search Google Scholar
    • Export Citation
  • 17.

    Maciunas RJGalloway RL JrLatimer Jet al: An independent application accuracy evaluation of stereotactic frame systems. Stereotact Funct Neurosurg 58:1031071992Maciunas RJ Galloway RL Jr Latimer J et al: An independent application accuracy evaluation of stereotactic frame systems. Stereotact Funct Neurosurg 58:103–107 1992

    • Search Google Scholar
    • Export Citation
  • 18.

    Rohling RMunger PHollerbach JMet al: Comparison of accuracy between a mechanical and an optical tracker for image-guided neurosurgery. J Image Guided Surg 1:30341995Rohling R Munger P Hollerbach JM et al: Comparison of accuracy between a mechanical and an optical tracker for image-guided neurosurgery. J Image Guided Surg 1:30–34 1995

    • Search Google Scholar
    • Export Citation
  • 19.

    Sandeman DRPatel NChandler Cet al: Advances in image-directed neurosurgery: preliminary experience with the ISG Viewing Wand compared with the Leksell G frame. Br J Neurosurg 8:5295441994Sandeman DR Patel N Chandler C et al: Advances in image-directed neurosurgery: preliminary experience with the ISG Viewing Wand compared with the Leksell G frame. Br J Neurosurg 8:529–544 1994

    • Search Google Scholar
    • Export Citation
  • 20.

    Sipos EPTebo SAZinreich SJet al: In vivo accuracy testing and clinical experience with the ISG Viewing Wand. Neurosurgery 39:1942021996Sipos EP Tebo SA Zinreich SJ et al: In vivo accuracy testing and clinical experience with the ISG Viewing Wand. Neurosurgery 39:194–202 1996

    • Search Google Scholar
    • Export Citation
  • 21.

    Spetzger ULaborde GGilsbach JM: Frameless neuronavigation in modern neurosurgery. Minim Invasive Neurosurg 38:1631661995Spetzger U Laborde G Gilsbach JM: Frameless neuronavigation in modern neurosurgery. Minim Invasive Neurosurg 38:163–166 1995

    • Search Google Scholar
    • Export Citation
  • 22.

    Vrionis FDFoley KTRobertson JHet al: Use of cranial surface anatomical fiducials for interactive image-guided navigation in the temporal bone: a cadaveric study. Neurosurgery 40:7557641997Vrionis FD Foley KT Robertson JH et al: Use of cranial surface anatomical fiducials for interactive image-guided navigation in the temporal bone: a cadaveric study. Neurosurgery 40:755–764 1997

    • Search Google Scholar
    • Export Citation

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