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Huan Liu, Junlong Wu, Yu Tang, Haiyin Li, Wenkai Wang, Changqing Li, and Yue Zhou

dependent on the guidance by intraoperative fluoroscopy. AR technology could provide an overlay of not only the intraoperative fluoroscopic images, but also the patient’s 3D anatomical structures, which could improve the surgeon’s experience and provide an easier way to overcome the learning curve with MIS procedures. Here, we aimed to assess, in bone-agar experimental settings, the feasibility and accuracy of percutaneous lumbar pedicle screw placements using a CT image–based AR-guided method compared to placements using a radiograph-guided method. We also compared two

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Jason G. Mandell, Jack W. Langelaan, Andrew G. Webb, and Steven J. Schiff

neurological pathology as well as for CT data. Image segmentation for application to CT images remains exceedingly important, given that much of the developing world does not have access to MRI. Additionally, much emergency imaging and many critical vascular studies in industrialized countries are done with CT. In this study, we sought to lay the foundation for an intelligent automated edge tracker that is modality independent and has the capability to segment normative data from MRI that can be applied to both MRI and CT. A probabilistic approach using methods developed

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Lennart Riemann, Daphne C. Voormolen, Katrin Rauen, Klaus Zweckberger, Andreas Unterberg, Alexander Younsi, and the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants

but has been reported to be as high as 31%. 5 Although the knowledge about such postconcussive symptoms in the pediatric and adolescent population has considerably increased over the past years and now includes insights from large, multicenter studies, 5 , 6 there remains an important subgroup of patients who have not been studied in detail: young mTBI patients requiring head CT during initial assessment following the brain injury. While, to avoid radiation exposure, the majority of adolescents and children do not receive CT imaging after mTBI, it might be

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Andrés Monserrate, Benjamin Zussman, Alp Ozpinar, Ajay Niranjan, John C. Flickinger, and Peter C. Gerszten

orthogonal to the linear accelerator, the CBCT image guidance system is mounted on the gantry. The accelerators are equipped with a couch that allows for patient positioning correction in 3 translational and 3 rotational directions. Patients are immobilized with the Body-Fix (total body bag, Medical Intelligence) when treatment sites are below T-6. Otherwise, a head and shoulder mask with S-board (CIVCO Medical Solutions) is used. CT images (1.5-mm slice thickness) were used to plan all spine radiosurgery treatments. Initial patient setup was performed based on external

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Douglas S. Cohen, Jonathan H. Lustgarten, Erik Miller, Alexander G. Khandji, and Robert R. Goodman

multimodal approach to stereotactic imaging. In coregistering MR and CT images we have eliminated the necessity of an MR image with a fiducial headring in place. In this study we have examined the accuracy of coregistration of fiducial CT images using the Brown-Roberts-Wells and Cosman-Roberts-Wells (BRW/CRW) system with standard MR images. We then compared the anatomical accuracy of the coregistered MR image with that of an MR fiducial image (using the BRW/CRW device). We have performed these comparisons in a lucite phantom as well as in patients. Clinical Material

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Yeliz Pekcevik and Hilal Sahin

TO THE EDITOR: We read with great interest the paper by Orman et al. 2 (Orman G, Wagner MW, Seeburg D, et al: Pediatric skull fracture diagnosis: should 3D CT reconstructions be added as routine imaging? J Neurosurg Pediatr 16: 426–431, October 2015). The authors investigated the efficacy of combining 3D CT images with 2D CT images and found it useful in the diagnosis of linear skull fractures in all children. They also showed increased specificity with 3D CT images in the interpretation of linear fractures in children younger than 2 years of age. We also

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Daniel S. Yanni, Burak M. Ozgur, Robert G. Louis, Yevgenia Shekhtman, Rajiv R. Iyer, Venkat Boddapati, Asha Iyer, Purvee D. Patel, Raja Jani, Matthew Cummock, Aalap Herur-Raman, Phuong Dang, Ira M. Goldstein, Michael Brant-Zawadzki, Thomas Steineke, and Lawrence G. Lenke

more complex procedures. While another HoloLens-based platform used DRF for patient tracking, fluoroscopy was utilized for the intraoperative imaging technique, which the authors reported as time consuming. 25 Furthermore, occupational radiation exposure is higher in fluoroscopy-guided procedures than in CT-guided procedures. 31 Currently, xvision (Augmedics) is a commercially available platform that uses DRF patient tracking with intraoperative CT imaging to provide an ARHMD navigation system with wireless infrared-based optical tracking cameras inside the

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Analiz Rodriguez, Matthew T. Neal, Ann Liu, Aravind Somasundaram, Wesley Hsu, and Charles L. Branch Jr

Object

Symptomatic adjacent-segment lumbar disease (ASLD) after lumbar fusion often requires subsequent surgical intervention. The authors report utilizing cortical bone trajectory (CBT) pedicle screw fixation with intraoperative CT (O-arm) image-guided navigation to stabilize spinal levels in patients with symptomatic ASLD. This unique technique results in the placement of 2 screws in the same pedicle (1 traditional pedicle trajectory and 1 CBT) and obviates the need to remove preexisting instrumentation.

Methods

The records of 5 consecutive patients who underwent lumbar spinal fusion with CBT and posterior interbody grafting for ASLD were retrospectively reviewed. All patients underwent screw trajectory planning with the O-arm in conjunction with the StealthStation navigation system. Basic demographics, operative details, and radiographic and clinical outcomes were obtained.

Results

The average patient age was 69.4 years (range 58–82 years). Four of the 5 surgeries were performed with the Minimal Access Spinal Technologies (MAST) Midline Lumbar Fusion (MIDLF) system. The average operative duration was 218 minutes (range 175–315 minutes). In the entire cohort, 5.5-mm cortical screws were placed in previously instrumented pedicles. The average hospital stay was 2.8 days (range 2–3 days) and there were no surgical complications. All patients had more than 6 months of radiographic and clinical follow-up (range 10–15 months). At last follow-up, all patients reported improved symptoms from their preoperative state. Radiographic follow-up showed Lenke fusion grades of A or B.

Conclusions

The authors present a novel fusion technique that uses CBT pedicle screw fixation in a previously instrumented pedicle with intraoperative O-arm guided navigation. This method obviates the need for hardware removal. This cohort of patients experienced good clinical results. Computed tomography navigation was critical for accurate CBT screw placement at levels where previous traditional pedicle screws were already placed for symptomatic ASLD.

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Hiroki Hori, Hirokazu Iwamuro, Masayuki Nakano, Takahiro Ouchi, Takashi Kawahara, Takaomi Taira, Keiichi Abe, Ken Iijima, and Toshio Yamaguchi

compare the heating efficiency using different skull computed tomography (CT) images given the different CT equipment manufacturers and reconstruction functions. The variability of the SDR may be induced by fluctuations in the HU values of cortical bone and marrow bone because the modulation transfer function (MTF), which reflects the high-contrast resolution of the image and obtains the measurement value corresponding to the spatial frequency, differs for each reconstruction filter developed by CT scanner manufacturers. Even in the bone filter, each manufacturer has

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Henry Hirschberg

: Scalp marking of intracranial lesions using computed tomography (CT) images. A technical note. Acta Neurochir 80 : 62 – 64 , 1986 Patil AA, Woosley RE: Scalp marking of intracranial lesions using computed tomography (CT) images. A technical note. Acta Neurochir 80: 62–64, 1986 8. Wester K , Sortland O , Hauglie-Hanssen E : A simple and inexpensive method for CT-guided stereotaxy. Neuroradiology 20 : 255 – 256 , 1981 Wester K, Sortland O, Hauglie-Hanssen E: A simple and inexpensive method for CT