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59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

01. - 04.06.2008, Würzburg

“Sliding Gantry” intraoperative computer tomography in neurosurgical procedures

Intraoperative Computertomographie mit "Sliding Gantry" in neurochirurgischen Operationen

Meeting Abstract

  • corresponding author J. Tilgner - Klinik für Neurochirurgie, Universitätsklinikum Heidelberg
  • K. Kiening - Klinik für Neurochirurgie, Universitätsklinikum Heidelberg
  • S. Rohde - Abt. Neuroradiologie, Klinik für Neurologie, Universitätsklinikum Heidelberg
  • O. Sakowitz - Klinik für Neurochirurgie, Universitätsklinikum Heidelberg
  • A. Unterberg - Klinik für Neurochirurgie, Universitätsklinikum Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 081

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2008/08dgnc349.shtml

Veröffentlicht: 30. Mai 2008

© 2008 Tilgner et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Intraoperative computertomography (CT) aims to improve neurosurgical procedures due to safety and time saving especially in standard stereotactic procedures, functional neurosurgery and spinal navigation. We hereby report first results of a fixed installed intraoperative CT scanner (“sliding gantry” CT).

Methods: In a 26 months period 87 neurosurgical operations were reviewed. (1) Time saving in stereotactic biopsies, (2) correct location of deep brain stimulation (DBS) leads, (3) navigation of spinal screws and (4) if intraoperative computertomography changed the course of the operation were documented. The CT scanner (Siemens Emotion) is a modified, non-mobile single-line scanner which is fixed on a rail-system (“sliding gantry”) in the operating room (OR). In combination, the OR is equipped with a computer-controlled carbon operating table (cOT). Thus, CT and cOT can be approximated separately to avoid collision. The cOT is equipped with different carbon head fixation systems such as a Mayfield clamp and intraoperative images were evaluated by a neuroradiologist.

Results: (1) Mean time saving for standard CT-based stereotactic biopsy (20 cases) was 30 min. (2) DBS lead positions were checked intraoperatively in 36 cases. Fusion of preoperative MRI with intraoperative CT revealed correct lead placement, thus no lead had to be repositioned. (3) In 31 cases of spinal (C1-C7, Th1-4, L2-S1) navigations (pedicle and lateral mass screws), the mean deviation of calculated registration was 1.1 mm (range: 0.9 – 1.3). Immediate intraoperative CT verified correct screw positions in all but two cases. (4) In 11/87 cases, intraoperative CT changed the course of the operation, therefore avoiding a second intervention for the patient.

Conclusions: Intraoperative CT scanning allows optimal spinal navigation. It saves time in stereotactic biopsies, verifies immediately correct DBS lead implantation and avoids further operations. Because of restricted indications and its high costs such systems should be used only in a multidisciplinary setting.