gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

First experiences with the microscope integrated intraoperative optical imaging module from Zeiss

Erste Erfahrungen mit dem mikroskopintegrierten Intraoperative Optical Imaging Modul von Zeiss

Meeting Abstract

  • presenting/speaker Martin Oelschlägel - Technische Universität Dresden, Medizinische Fakultät Carl Gustav Carus, Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Klinisches Sensoring und Monitoring, Dresden, Deutschland
  • Witold H. Polanski - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Gerald Steiner - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Klinisches Sensoring und Monitoring, Dresden, Deutschland
  • Edmund Koch - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Klinisches Sensoring und Monitoring, Dresden, Deutschland
  • Gabriele Schackert - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Stephan B. Sobottka - Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV087

doi: 10.3205/22dgnc090, urn:nbn:de:0183-22dgnc0900

Published: May 25, 2022

© 2022 Oelschlägel 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

Text

Objective: Intraoperative Optical Imaging (IOI) is a marker free and non-invasive imaging technique that has proven to be useful for visualization of hemodynamic changes and therefore functional areas of the human cerebral cortex during neurosurgical interventions. In the past, we refined and evolved the method towards a clinical tool that has now been integrated by Zeiss as a Software add-on into the commercial available Kinevo microscope. Here, we are presenting our experiences and results of the first application of the system.

Methods: The IOI-Software was used during surgery of 17 patients (8 female, 9 male, median age 60 years). A total of 46 datasets were acquired. Stimulation was performed according to the predefined stimulation paradigm of 9 minutes with alternating 30 second rest and stimulation trials. Image data was acquired and evaluated using the red channel of the integrated camera. Sensory stimulation was performed either tactile on the corresponding body part or electrical on the median nerve of the hand (11 patients). Three patients underwent surgery under local anesthesia. Here, motor as well as speech tasks, dependent of lesion localization, were performed to visualize the corresponding functional areas. Another three patients were stimulated visually using flashlight goggles under general anesthesia.

Results: The results reveal that the identification of functional brain areas with the microscope-integrated software is reliably possible. In 12 of the 17 patients, we were able to acquire at least one dataset that revealed a map of spatially delineated activity (true positive). In two patients, the postoperative analysis revealed that the anatomical region, corresponding with the stimulated function, was not trepanned (true negative). In the other three patients, data could not properly evaluated due to subarachnoidal tumor bleeding or technical problems occurred with the stimulation device. In respect to the functionality and reliability of the software, we experienced no severe problems.

Conclusion: The new IOI-Software allows an easy and reliable intraoperative visualization of superficial functional brain areas such as sensory, visual, motor, and speech cortex. A good user guidance and assistance during adjustment of image section and illumination brightness are implemented. Minor improvements in respect to the used visualization threshold or the accuracy of the automatic segmentation of trepanned region should be included in future releases.