Int J Comput Assist Radiol Surg - The role of automatic computer-aided surgical trajectory planning in improving the expected safety of stereotactic neurosurgery.

Tópicos

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Resumo

RPOSE: Minimal invasion computer-assisted neurosurgical procedures with various tool insertions into the brain may carry hemorrhagic risks and neurological deficits. The goal of this study is to investigate the role of computer-based surgical trajectory planning tools in improving the potential safety of image-based stereotactic neurosurgery.METHODS: Multi-sequence MRI studies of eight patients who underwent image-guided neurosurgery were retrospectively processed to extract anatomical structures-head surface, ventricles, blood vessels, white matter fibers tractography, and fMRI data of motor, sensory, speech, and visual areas. An experienced neurosurgeon selected one target for each patient. Five neurosurgeons planned a surgical trajectory for each patient using three planning methods: (1) conventional; (2) visualization, in which scans are augmented with overlays of anatomical structures and functional areas; and (3) automatic, in which three surgical trajectories with the lowest expected risk score are automatically computed. For each surgeon, target, and method, we recorded the entry point and its surgical trajectory and computed its expected risk score and its minimum distance from the key structures.RESULTS: A total of 120 surgical trajectories were collected (5 surgeons, 8 targets, 3 methods). The surgical trajectories expected risk scores improved by 76% ([Formula: see text], two-sample student's t test); the average distance of a trajectory from nearby blood vessels increased by 1.6 mm ([Formula: see text]) from 0.6 to 2.2 mm (243%). The initial surgical trajectories were changed in 85% of the cases based on the expected risk score and the trajectory distance from blood vessels.CONCLUSIONS: Computer-based patient-specific preoperative planning of surgical trajectories that minimize the expected risk of vascular and neurological damage due to incorrect tool placement is a promising technique that yields consistent improvements.

Resumo Limpo

rpose minim invas computerassist neurosurg procedur various tool insert brain may carri hemorrhag risk neurolog deficit goal studi investig role computerbas surgic trajectori plan tool improv potenti safeti imagebas stereotact neurosurgerymethod multisequ mri studi eight patient underw imageguid neurosurgeri retrospect process extract anatom structureshead surfac ventricl blood vessel white matter fiber tractographi fmri data motor sensori speech visual area experienc neurosurgeon select one target patient five neurosurgeon plan surgic trajectori patient use three plan method convent visual scan augment overlay anatom structur function area automat three surgic trajectori lowest expect risk score automat comput surgeon target method record entri point surgic trajectori comput expect risk score minimum distanc key structuresresult total surgic trajectori collect surgeon target method surgic trajectori expect risk score improv formula see text twosampl student t test averag distanc trajectori nearbi blood vessel increas mm formula see text mm initi surgic trajectori chang case base expect risk score trajectori distanc blood vesselsconclus computerbas patientspecif preoper plan surgic trajectori minim expect risk vascular neurolog damag due incorrect tool placement promis techniqu yield consist improv

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