gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Cost-efficient craniotomy planning of EC-IC bypass surgery with a self-developed software tool and its validation through transdural ICG-videoangiography

Meeting Abstract

  • Philippe Dodier - Klinikfür Neurochirurgie, Medizinische Universität Wien, Austria
  • Firas Hammadi - Klinik für Neurochirurgie, DRK Krankenhaus Neuwied, Germany
  • Wei-Te Wang - Klinikfür Neurochirurgie, Medizinische Universität Wien, Austria
  • Engelbert Knosp - Klinikfür Neurochirurgie, Medizinische Universität Wien, Austria
  • Andreas Gruber - Klinikfür Neurochirurgie, Medizinische Universität Wien, Austria
  • Gerhard Bavinzski - Klinikfür Neurochirurgie, Medizinische Universität Wien, Austria

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMO.05.04

doi: 10.3205/16dgnc025, urn:nbn:de:0183-16dgnc0259

Published: June 8, 2016

© 2016 Dodier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objective: Increased usage of neuronavigation systems have led to the authors’ experience, that definitive planning of craniotomy and skin incision placement is often decided after referencing of the navigation system in the OR. In times of drastic reduction of working time of hospital physicians in compliance with EU rules and overcrowded outpatient clinics, neurosurgeons face a time management challenge that results in less time being spent on preoperative planning. We present our experiences using a self-developed bone removal plug-in to plan skin incision and minimalinvasive craniotomy in revascularization surgery and its validation through transdural ICGangiography.

Method: Based on the previously presented 5-step algorithm called Maximum-Minimal-Protocol, a simple virtual bone removal tool has been developed in cooperation with the Vienna Technical University, Institute of Computer Graphics, as a plug-in for the 64-bit, FDA cleared version of the OsiriX software (Pixmeo, Geneva, Switzerland), an open source medical image processing software and DICOM viewer. By reconstructing VR models of STA (donor) and MCA (recipient) branches in preoperative CT-A scans, an individually tailored approach was planned with a „1-click“ option, measured and transferred to the patient skin before final positioning. Before dural opening, validation of the preoperatively planned recipient artery was performed by indocyanine green video-angiography (ICG-VA).

Results: We present our series of the first ten consecutive patients undergoing revascularization surgery (EC-IC bypass, indirect revascularization for Moya-Moya) under Maximum-Minimal-Protocol planning. In all cases, preoperative identification and segmentation of donor/ recipient vessels and exact placement of minimally-invasive craniotomy with our bone removal plug-in took <2min. The transfer and plot of the measured coordinates and vessels on patient skin in the OR lasted less than 60sec and proved in 100% to be remarkably accurate, as the validation through transdural ICG-VA and post-operative CT-A scans demonstrated.

Conclusions: We present our promising and validated first experiences planning and simulating minimalinvasive approaches in EC-IC bypass surgery with a newly developed bone removal software tool. This tool – in combination with the Maximum-Minimal-Protocol – circumvents the necessity for neuronavigation in the cases described above and guarantees a maximum of time- (and therefore cost-) efficiency in the OR.