Tag: 3D fluoroscopy

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The accuracy of 3D fluoroscopy (XT) vs computed tomography (CT) registration in deep brain stimulation (DBS) surgery

Acta Neurochirurgica (2020) 162:1871–1878

Stereotactic registration is the most critical step ensuring accuracy in deep brain stimulation (DBS) surgery. 3D fluoroscopy (XT) is emerging as an alternative to CT. XT has been shown to be safe and effective for intraoperative confirmation of lead position following implantation. However, there is a lack of studies evaluating the suitability ofXT to be used for themore crucial step of registration and its capability of being merged to a preoperative MRI. This is the first study comparing accuracy, efficiency, and radiation exposure of XT- vs CT-based stereotactic registration and XT/MRI merging in deep brain stimulation.

Methods Mean absolute differences and Euclidean distance between planned (adjusted for intraoperative testing) and actual lead trajectories were calculated for accuracy of implantation. The radiation dose from each scan was recorded as the dose length product (DLP). Efficiency was measured as the time between the patient entering the operating room and the initial skin incision. A one-way ANOVA compared these parameters between patients that had either CT- or XT-based registration.

Results Forty-one patients underwent DBS surgery—25 in the CT group and 16 in the XT group. The mean absolute difference between CT and XTwas not statistically significant in the x (p = 0.331), y (p = 0.951), or z (p = 0.807) directions. The Euclidean distance between patient groups did not differ significantly (p = 0.874). The average radiation exposure with XT (220.0 ± 0.1 mGy*cm) was significantly lower than CT (1269.3 ± 112.9 mGy*cm) (p < 0.001). There was no significant difference in registration time between CT (107.8 ± 23.1 min) and XT (106.0 ± 18.2 min) (p = 0.518).

Conclusion XT-based frame registration was shown to result in similar implantation accuracy and significantly less radiation exposure compared with CT. Our results surprisingly showed no significant difference in registration time, but this may be due to a learning curve effect.

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Spine Navigation Based on 3-Dimensional Robotic Fluoroscopy for Accurate Percutaneous Pedicle Screw Placement

World Neurosurg. (2017) 108:76-83.

Minimally invasive spine surgery is associated with obstructed visibility of anatomic landmarks and increased radiation exposure, leading to higher incidence of pedicle screw mispositioning. To address these drawbacks, intraoperative 3-dimensional fluoroscopy (io3DF) and navigation are being increasingly used. We aimed to present our dedicated multifunctional hybrid operating room (HyOR) setup and evaluate the accuracy and safety of io3DF image-guided spinal navigation in transforaminal lumbar interbody fusion with percutaneous pedicle screw (PPS) placement.

METHODS: The HyOR includes a fixed 3D multiaxis robotic fluoroscopy arm that moves automatically to the preprogrammed position when needed. An initial io3DF assessment is performed to collect intraoperative images, which are automatically transferred into the navigation system. These data are used to calibrate the PPSs and insert them under computer-assisted navigation. A second io3DF is performed for verifying PPS position.

RESULTS: Between January 2014 and December 2016, 66 consecutive patients (age, 58.6  14.1 years) were treated for refractory lumbar degenerative pain. Seventy-three spinal levels were treated, and 276 screws were placed, with 4.2 ± 0.76 screws per patient. There was no measurable radiation to the HyOR staff, whereas the mean radiation dose per patient was 378.3  uGym2. The overall accuracy rate of PPS placement was 99.6%. There were no significant procedure-related complications.

CONCLUSIONS: Spine navigation based on io3DF images enabled us to avoid radiation exposure to the operating room team while delivering minimal but sufficient radiation doses to our patients. This approach achieved an accuracy rate of 99.6% for PPS placement in the safe zone, without significant complications.

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