Auditory feedback during frameless image-guided surgery in a phantom model and initial clinical experience

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In this study the authors measured the effect of auditory feedback during image-guided surgery (IGS) in a phantom model and in a clinical setting. In the phantom setup, advanced IGS with complementary auditory feedback was compared with results obtained with 2 routine forms of IGS, either with an on-screen image display or with imageinjection via a microscope. The effect was measured by means of volumetric resection assessments. The authors also present their first clinical data concerning the effects of complementary auditory feedback on instrument handling during image-guided neurosurgery. When using image-injection through the microscope for navigation, however, resection quality was significantly worse. In the clinical portion of the study, the authors performed resections of cerebral mass lesions in 6 patients with the aid of auditory feedback. Instrument tip speeds were slightly (although significantly) influenced by this feedback during resection. Overall, the participating neurosurgeons reported that the auditory feedback helped in decision-making during resection without negatively influencing instrument use. Postoperative volumetric imaging studies revealed resection rates of ≥ 95% when IGS with auditory feedback was used. There was only a minor amount of brain shift, and postoperative resection volumes corresponded well with the preoperative intentions of the neurosurgeon. Although the results of phantom surgery with auditory feedback revealed no significant effect on resection quality or extent, auditory cues may help prevent damage to eloquent brain structures.

Abbreviations used in this paper: HUD = heads-up display; IGS = image-guided surgery.

Article Information

Address correspondence to: Peter A. Woerdeman, M.D., University Medical Center Utrecht (G03.124), Department of Neurosurgery, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. email: p.a. woerdeman@neuro.azu.nl.

© AANS, except where prohibited by US copyright law."

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Figures

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    Photographs of typical situations during the phantom experiments. Left: Phantom resection experiment using standard IGS techniques. Notice the surgeon's visual focus on the computer screen of the neuronavigation workstation. Right: Surgeon performing a phantom resection experiment using standard IGS and auditory feedback.

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    Screenshot of the logging of ultrasonic aspirator tip positions during an image-guided resection procedure of a lowgrade oligodendroglioma. The auditory feedback mode is active.

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    Postresection cross-sectional CT images (midsagittal) of the 12 floral foam blocks. The white lines indicate the outline of the target volume. The dashed white line represents the entrance of the resection cavity. In the area above this line, the floral foam was eroded by the ultrasonic aspirator shaft. Consequently, this volume was excluded from analysis.

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    Bar graph showing overall resection data of the 3 modes of IGS. Note the significant lower similarity and higher nonresected target volume in the IGS with HUD group.

References

1

Eljamel MS: Frameless stereotactic neurosurgery: two steps towards the Holy Grail of surgical navigation. Stereotact Funct Neurosurg 72:1251281999

2

Germano IMVillalobos HSilvers APost KD: Clinical use of the optical digitizer for intracranial neuronavigation. Neurosurgery 45:2612701999

3

Golfinos JGFitzpatrick BCSmith LRSpetzler RF: Clinical use of a frameless stereotactic arm: results of 325 cases. J Neurosurg 83:1972051995

4

Gumprecht HKWidenka DCLumenta CB: BrainLab VectorVision Neuronavigation System: technology and clinical experiences in 131 cases. Neurosurgery 44:971051999

5

King APEdwards PJMaurer CR Jrde Cunha DAHawkes DJHill DL: A system for microscope-assisted guided interventions. Stereotact Funct Neurosurg 72:1071111999

6

Nimsky CGanslandt OFahlbusch R: Implementation of fiber tract navigation. Neurosurgery 58:4 SupplONS292ONS3042006

7

Noordmans HJRutten GJMWillems PWvan Veelen CWMvan Rijen PCViergever MA: Volume rendering for neurosurgical planning. Proc SPIE 4158:1641732001

8

Roessler KUngersboeck KAichholzer MDietrich WCzech THeimberger K: Image-guided neurosurgery comparing a pointer device system with a navigating microscope: a retrospective analysis of 208 cases. Minim Invasive Neurosurg 41:53571998

9

Roessler KUngersboeck KCzech TAichholzer MDietrich WGoerzer H: Contour-guided brain tumor surgery using a stereotactic navigating microscope. Stereotact Funct Neurosurg 68:33381997

10

Spetzger ULaborde GGilsbach JM: Frameless neuronavigation in modern neurosurgery. Minim Invasive Neurosurg 38:1631661995

11

Willems PWNoordmans HJvan Overbeeke JJViergever MATulleken CABerkelbach van der Sprenkel JW: The impact of auditory feedback on neuronavigation. Acta Neurochir (Wien) 147:1671732005

12

Willems PWTaphoorn MJBurger HBerkelbach van der Sprenkel JWTulleken CA: Effectiveness of neuronavigation in resecting solitary intracerebral contrast-enhancing tumors: a randomized controlled trial. J Neurosurg 104:3603682006

13

Willems PWBerkelbach van der Sprenkel JWTulleken CAViergever MATaphoorn MJ: Neuronavigation and surgery of intracerebral tumours. J Neurol 253:112311362006

14

Woerdeman PAWillems PWNoordmans HJBerkelbach van der Sprenkel JW: The effect of repetitive manual fiducial localization on target localization in image space. Neurosurgery 60:2 SupplONS100ONS1042007

15

Woerdeman PAWillems PWNoordmans HJTulleken CABerkelbach van der Sprenkel JW: Application accuracy in frameless image-guided neurosurgery: a comparison study of three patient-to-image registration methods. J Neurosurg 106:101210162007

16

Woerdeman PAWillems PWNoordmans HJBerkelbach van der Sprenkel JW: The analysis of intraoperative neurosurgical instrument movement using a navigation log-file. Int J Med Robot 2:1391452006

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