gms | German Medical Science

60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Compensation for brain shift by updating navigation with intraoperative image data in glioma surgery

Meeting Abstract

  • D. Kuhnt - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg
  • B. von Keller - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg
  • S. Schlaffer - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg
  • O. Ganslandt - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg
  • M. Buchfelder - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg
  • C. Nimsky - Klinik für Neurochirurgie, Universität Erlangen-Nürnberg

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP02-09

DOI: 10.3205/09dgnc269, URN: urn:nbn:de:0183-09dgnc2693

Published: May 20, 2009

© 2009 Kuhnt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: The localization of residual tumor in glioma surgery using updated navigation by intraoperative magnetic resonance imaging (MRI) compensating for the effects of brain shift.

Methods: 288 patients with high or low grade gliomas were investigated by combined use of intraoperative high-field (1.5T) MRI and navigation. Among these, in 84 cases an update of the navigation was performed. After registration of intraoperative image data with the preoperative image data, the tumor remnant was segmented. The initial patient registration was restored, so that the registration coordinate system of the preoperative data was applied on the intraoperative scans. Therefore, there was no need for an intraoperative patient registration.

Results: An update of the navigation was reliably possible in all cases. Landmark checks proved high accuracy of pre- and intraoperative images. The target registration error of the preoperative registration was 1.74 ± 0.63 mm. Updating of navigation resulted in further resections in 89.29%. Completion after further resection was possible in 25 patients (29.76%). Further but incomplete resection was therefore performed in 50 patients (59.52%).

Conclusions: An update of navigation with intraoperative image data is reliably possible without repeated patient registration, facilitating the update procedure. Subsequently, with the help of updated navigation, enlarged resections and compensation for the effects of brain shift are possible.