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The role of automatic computer-aided surgical trajectory planning in improving the expected safety of stereotactic neurosurgery

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

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 % (\(\hbox {SD} =11.6\,\%; p < 0.05\), two-sample student’s t test); the average distance of a trajectory from nearby blood vessels increased by 1.6 mm (\(\hbox {SD}=0.5, p < 0.05\)) 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.

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Acknowledgments

Neurosurgeons Zvi Israel, Guy Rosenthal, Iddo Paldor, Fernando Ramirez and Shweiki Moatasim participated in this study.

Conflict of interest

None of the authors has any conflict of interest. The authors have no personal financial or institutional interest in any of the materials, software, or devices described in this article.

Author information

Authors and Affiliations

  1. School of Engineering and Computer Science, The Hebrew University of Jerusalem, Givat Ram Campus, 91904, Jerusalem, Israel

    M. Trope & L. Joskowicz

  2. The Edmond and Lily Safra Center for Brain Research (ELSC), The Hebrew University of Jerusalem, Jerusalem, Israel

    R. R. Shamir & L. Joskowicz

  3. Department of Neurosurgery, Center for Functional and Restorative Neurosurgery, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel

    R. R. Shamir

  4. School of Medicine, Stanford University, Palo Alto, CA, USA

    Z. Medress

  5. Department of Neurosurgery, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel

    Z. Medress, G. Rosenthal & Y. Shoshan

  6. fMRI Unit, Department of Neuroradiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel

    A. Mayer, N. Levin & A. Bick

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  1. M. Trope
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  2. R. R. Shamir
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  3. L. Joskowicz
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  4. Z. Medress
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  5. G. Rosenthal
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  6. A. Mayer
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  7. N. Levin
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  8. A. Bick
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  9. Y. Shoshan
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Corresponding author

Correspondence to L. Joskowicz.

Additional information

A shorter and restricted version of this paper was orally presented at the 27th International Conference on Computer Aided Radiology and Surgery, Heidelberg, Germany, 2013.

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Trope, M., Shamir, R.R., Joskowicz, L. et al. The role of automatic computer-aided surgical trajectory planning in improving the expected safety of stereotactic neurosurgery. Int J CARS 10, 1127–1140 (2015). https://doi.org/10.1007/s11548-014-1126-5

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  • DOI: https://doi.org/10.1007/s11548-014-1126-5

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