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Michael A. Murphy, Terence J. O'Brien, Kevin Morris, and Mark J. Cook

epileptogenic focus. This approach has been termed “MMIGS.” The application of image-guided surgery for the treatment of epilepsy has improved our ability to resect lesions causing epilepsy. Currently, it is based on a T 1 -weighted volumetric MR image with high structural resolution and anatomical detail. Note that functional imaging modalities do not have the structural resolution to be used as IGSSs on their own. Image coregistration is applied to integrate the functional imaging data with high-resolution T 1 -weighted images ready for use in the IGSS. The purpose of

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Peter A. Woerdeman, Peter W. A. Willems, Herke Jan Noordmans, and Jan Willem Berkelbach van der Sprenkel

I mage - guided surgery is a widely used and accepted method of using imaging information to localize the spatial position of a navigated surgical instrument within the surgical field. 2–4 , 10 , 13 Unfortunately, complete spatial awareness at all times can be compromised during IGS, as information is displayed in 2D and can be difficult to interpret in 3D. Moreover, during these moments the surgeon's attention is drawn away from the actual surgical field. To maintain attention on the surgical field, an image-injection mode known as HUD has been

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Michael Schulder, Joseph A. Maldjian, Wen-Ching Liu, Andrei I. Holodny, Andrew T. Kalnin, In Ki Mun, and Peter W. Carmel

emission tomography (PET), 12 magnetoencephalography, 7, 13, 30 and functional magnetic resonance (fMR) imaging. 20, 22, 25 In recent years interactive, anatomical image-guided surgery has become available in the form of frameless stereotactic systems. These register a preoperative diagnostic image to surgical space with the aid of devices such as a digitized articulating arm 15 or detectors that track devices emitting ultrasound 5 or infrared light. 33 Thus, the possibility exists for combining noninvasive, preoperative brain mapping with interactive surgical

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Aygül Mert, Barbara Kiesel, Adelheid Wöhrer, Mauricio Martínez-Moreno, Georgi Minchev, Julia Furtner, Engelbert Knosp, Stefan Wolfsberger, and Georg Widhalm

protocol for neuronavigation that fulfills the specific requirements of modern glioma surgery. Thus, such a protocol for imaging and navigation setup for surgery of suspected LGGs is needed. The aim of the present study was therefore to define a multimodality imaging protocol for diffusely infiltrating gliomas with nonsignificant contrast enhancement on MRI with standardized image settings and specific indications for each modality. Subsequently, this new multimodality imaging protocol was prospectively clinically validated during advanced navigation-guided surgery for

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Eric W. Nottmeier, Stephen M. Pirris, Steven Edwards, Sherri Kimes, Cammi Bowman, and Kevin L. Nelson

in vivo study, we reported that no surgeon radiation exposure occurred in cbCT-based, 3D image-guided spinal surgery when the surgeon stood behind a lead shield in the OR during cbCT acquisition. 11 In the current study, radiation exposure at several unshielded locations in the OR was measured in 25 spinal surgery cases utilizing cbCT-based, 3D image guidance. Methods Institutional review board approval was obtained. Five badge dosimeters were placed at set locations in the OR during 25 spinal surgery cases in which cbCT-based, 3D image guidance was used

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J. Patrick Johnson, Doniel Drazin, Wesley A. King, and Terrence T. Kim

of incorporating image-guided surgery (IGS) into VATS. 13 , 14 , 24 In 2005, we published our experience with first-generation IGS technology, for which, in addition to visual feedback from the video camera, we were also able to add fluoroscopic imaging to help surgeons navigate in the deep thoracic cavity with more familiarity. 14 Unfortunately, the process of calibrating equipment required a point-matching registration procedure on the anterior surface of the spine to achieve registration of the IGS system with the spinal anatomy. This combination of IGS and

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Matthew J. Tormenti, Dean B. Kostov, Paul A. Gardner, Adam S. Kanter, Richard M. Spiro, and David O. Okonkwo

quality allows for improved accuracy during utilization of image-guided navigation systems. The new intraoperative CT scanner at our institution provides for improved image quality, and the accuracy of instrumentation reported herein confirms that. The introduction of intraoperative CT in the 1980s enabled surgeons to adapt their operative plans with up-to-date high-resolution imaging. 14 While the use of intraoperative CT scanning in spinal surgery is not new, 6 , 20 we believe we are the first to report its marriage to image guidance for instrumentation placement

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Sunil Jeswani, Doniel Drazin, Joseph C. Hsieh, Faris Shweikeh, Eric Friedman, Robert Pashman, J. Patrick Johnson, and Terrence T. Kim

Given the greater probability of error in placing pedicle screws in small thoracic pedicles, we retrospectively examined the accuracy of previous screw placements in patients with small thoracic pedicles that had been performed using intraoperative CT-guided navigation. In the present study, we analyze our experience with pedicle screw placements in thoracic pedicles with diameters ≤ 3 mm. To our knowledge, this is the first study in which the efficacy of CT image–guided surgery (CT-IGS) for placing pedicle screws in such small thoracic pedicles has been exclusively

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Joseph C. Hsieh, Doniel Drazin, Alexander O. Firempong, Robert Pashman, J. Patrick Johnson, and Terrence T. Kim

, particularly computed tomography image–guided surgery (CT-IGS), has emerged as an alternative to fluoroscopy-based techniques. The argument for CT-IGS has been most compelling in cases of brain and spinal cord tumors, trauma, complex deformity (acquired or congenital), obesity, osteoporosis, and revision surgery. In each of these instances, anatomy is significantly altered and difficulties are compounded by limitations in imaging visualization of bony landmarks. This study focuses on evaluating the performance of CT-IGS in the setting of primary versus revision spine surgery

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Harsh Wadhwa, Karen Malacon, Zachary A. Medress, Christopher Leung, Matthew Sklar, and Corinna C. Zygourakis

preoperative assessment, and a computed tomography angiogram (CTA) is often obtained preoperatively to carefully delineate vascular anatomy and provide guidance on safe screw placement. Use of intraoperative fluoroscopy or computer-assisted navigation during surgery may further reduce surgical complication risk and improve screw accuracy. 7 , 8 The Machine-vision Image Guided Surgery (MvIGS) system (7D Surgical, Inc.) is an intraoperative spinal navigation system that uses optical topographic imaging. Unlike other navigation systems that rely on intraoperative fluoroscopy