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Intraoperative computed tomography as reliable navigation registration device in 200 cranial procedures

  • Original Article - Neurosurgical technique evaluation
  • Published:
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Abstract

Background

Registration accuracy is a main factor influencing overall navigation accuracy. Standard fiducial- or landmark-based patient registration is user dependent and error-prone. Intraoperative imaging offers the possibility for user-independent patient registration. The aim of this paper is to evaluate our initial experience applying intraoperative computed tomography (CT) for navigation registration in cranial neurosurgery, with a special focus on registration accuracy and effective radiation dose.

Methods

A total of 200 patients (141 craniotomy, 19 transsphenoidal, and 40 stereotactic burr hole procedures) were investigated by intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Registration accuracy was measured by at least three skin fiducials that were not part of the registration process.

Results

Automatic registration resulted in high registration accuracy (mean registration error: 0.93 ± 0.41 mm). Implementation of low-dose scanning protocols did not impede registration accuracy (registration error applying the full dose head protocol: 0.87 ± 0.36 mm vs. the low dose sinus protocol 0.72 ± 0.43 mm) while a reduction of the effective radiation dose by a factor of 8 could be achieved (mean effective radiation dose head protocol: 2.73 mSv vs. sinus protocol: 0.34 mSv).

Conclusion

Intraoperative CT allows highly reliable navigation registration with low radiation exposure.

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Authors and Affiliations

  1. Department of Neurosurgery, University Marburg, Baldingerstrasse, 35033, Marburg, Germany

    Barbara Carl, Miriam Bopp, Benjamin Saß & Christopher Nimsky

  2. Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany

    Barbara Carl, Miriam Bopp, Benjamin Saß & Christopher Nimsky

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  1. Barbara Carl
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Corresponding author

Correspondence to Barbara Carl.

Ethics declarations

Informed consent was obtained from all individual participants included in the study. We obtained ethical approval for prospective archiving all relevant clinical and technical data with no need for further approval of retrospective analysis.

ᅟ

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript, except for that Ch. Nimsky has received a speaker honorarium from Brainlab.

Ethical standards

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

This article is part of the Topical Collection on Neurosurgical technique evaluation

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Carl, B., Bopp, M., Saß, B. et al. Intraoperative computed tomography as reliable navigation registration device in 200 cranial procedures. Acta Neurochir 160, 1681–1689 (2018). https://doi.org/10.1007/s00701-018-3641-6

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  • DOI: https://doi.org/10.1007/s00701-018-3641-6

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