Preoperative 3-Dimensional Angiography Data and Intraoperative Real-Time Vascular Data Integrated in Microscope-Based Navigation by Automatic Patient Registration Applying Intraoperative Computed Tomography

• Published in: World neurosurgery 2018-05, Vol.113, p.e414-e425
• Main Authors: Carl, Barbara, Bopp, Miriam, Chehab, Somar, Bien, Siegfried, Nimsky, Christopher
• Format: Article
• Language: English
• Subjects: 3-dimensional rotational angiography; Aneurysm and arteriovenous malformation surgery; Duplex ultrasonography; Indocyanin green angiography; Intraoperative computed tomography; Navigation registration
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.02.045

To establish a workflow integrating preoperative 3-dimensional (3D) angiography data and intraoperative real-time vascular information in microscope-based navigation for aneurysm and arteriovenous malformation (AVM) surgery. In 7 patients (3 with AVMs and 4 with aneurysms), preoperative 3D rotational angiography or computed tomography (CT) or magnetic resonance angiography data were navigated applying a 32-slice movable CT scanner for low-dose registration scanning. The 3D vasculature was segmented and visualized by microscope-based navigation along with navigated intraoperative real-time imaging data from indocyanin green angiography and duplex ultrasonography. Automatic registration applying intraoperative CT resulted in high accuracy (registration error, 0.80 ± 0.79 mm). The effective radiation dose of the registration CT scans (0.28–0.42 mSv) was only approximately one-sixth of a standard diagnostic head CT scan. The 3D vessel architecture could be visualized accurately in the operating microscope heads-up display and on the navigation screens in the same projection as the view angle of the surgeon, both facilitating orientation in 3D space, providing a better understanding of anatomy. In addition, intraoperative real-time modalities could be coregistered with high precision, providing further information during the course of the vascular procedure. Registration CT imaging facilitates integrating preoperative and intraoperative vascular image data with a low registration error and low radiation exposure for the patient, improving the understanding of 3D vascular anatomy during surgery with easier identification of feeding vessels in AVMs, and of the projection and configuration of aneurysms. •Preoperative and intraoperative real-time vascular data can be integrated in a navigation setting with high accuracy via intraoperative registration scanning applying a movable computed tomography scanner.•Surgery for aneurysms and arteriovenous malformations can benefit from the 3-dimensional and 2-dimensional visualization of various angiography data in the surgical field, providing better understanding of the actual intraoperative anatomy.•Patient radiation exposure due to the registration scan is low compared with that from diagnostic computed tomography scans.