Abstract
Intraoperative 3D ultrasound (3D-iUS) may enhance the quality of neuronavigation by adding information about brain shift and tumor remnants. The aim of our study was to prove the concept of 3D ultrasound on the basis of technical and human effects. A 3D-ultrasound navigation system consisting of a standard personal computer containing a video grabber card in combination with an optical tracking system (NDI Polaris) and a standard ultrasound device (Siemens Omnia) with a 7.5 MHz probe was used. 3D-iUS datasets were acquired after craniotomy, at different subsequent times of the procedure and overlaid with preoperative MRI. All patients underwent early postoperative 3D MRI including contrast agent within 24 hours after surgery. Acquisition of 3D iUS and the fusion with preoperative MRI was successful in 22/23 patients. The expenditure of time was at least 5 minutes for one intraoperative 3D US dataset. The technique was used three to seven times during surgery. The quality of the ultrasound images was superior in cases of metastasis, meningeoma and angioma over those in malignant glioma. Brain shifting ranged from 2-25 mm depending on localization and kind of tumor. A resection control was possible in 78%. All six neurosurgeons demonstrated a learning curve. The introduction of 3D ultrasound has increased the value of neuronavigation substantially, making it possible to update several times during surgery and minimize the problem of brain shift. Configuration of both the 3D iUS based on a standard ultrasound system and the MR navigation system is time- and especially cost-effective. Faster navigational datasets and more intuitive image-guided surgery enable novel and user-friendly display techniques.
Key words
Neuronavigation - intraoperative ultrasound - tumor resection - brain shift
References
-
1
Bonsanto MM, Staubert A, Wirtz CR, Tronnier V, Kunze S.
Initial experience with an ultrasound-integrated single-RACK neuronavigation system.
Acta Neurochir (Wien).
2001;
143
1127-1132
-
2
Dohrmann GJ, Rubin JM.
History of intraoperative ultrasound in neurosurgery.
Neurosurg Clin N Am.
2001;
12
155-166
-
3
Unsgaard G, Ommedal S, Muller T, Gronningsaeter A, Nagelhus Hernes TA.
Neuronavigation by intraoperative three-dimensional ultrasound: initial experience during brain tumor resection.
Neurosurgery.
2002;
50
804-812
-
4
Wirtz CR, Tronnier VM, Bonsanto MM, Hassfeld S, Knauth M, Kunze S.
[Neuronavigation. Methods and prospects].
Nervenarzt.
1998;
69
1029-1036
-
5
Woydt M, Horowski A, Krauss J, Krone A, Soerensen N, Roosen K.
Three-dimensional intraoperative ultrasound of vascular malformations and supratentorial tumors.
J Neuroimaging.
2002;
12
28-34
-
6
Nabavi A, Gering DT, Kacher DF, Talos IF, Wells WM, Kikinis R, Black PM, Jolesz FA.
Surgical navigation in the open MRI.
Acta Neurochir.
2003;
85
((Suppl))
121-125
-
7
Nimsky C, Ganslandt O, von Keller B, Romstock J, Fahlbusch R.
Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients.
Radiology.
2004;
233
67-78
-
8
Yonekawa Y.
Intraoperative imaging in neurosurgery. MRI, CT, ultrasound. Postscript.
Acta Neurochir.
2003;
85
((Suppl))
143-144
-
9
Johnson I.
Intra-operative ultrasound.
J Neurosurg Nurs.
1984;
16
208-210
-
10
Suhm N, Dams J, van Leyen K, Lorenz A, Bendl R.
Limitations for three-dimensional ultrasound imaging through a bore-hole trepanation.
Ultrasound Med Biol.
1998;
24
663-671
-
11
Trantakis C, Meixensberger J, Lindner D, Strauss G, Grunst G, Schmidtgen A, Arnold S.
Iterative neuronavigation using 3D ultrasound. A feasibility study.
Neurol Res.
2002;
24
666-670
-
12
Lindseth F, Kaspersen JH, Ommedal S, Lango T, Bang J, Hokland J, Unsgaard G, Hernes TA.
Multimodal image fusion in ultrasound-based neuronavigation: improving overview and interpretation by integrating preoperative MRI with intraoperative 3D ultrasound.
Comput Aided Surg.
2003;
8
49-69
-
13
Gronningsaeter A, Kleven A, Ommedal S, Aarseth TE, Lie T, Lindseth F, Lango T, Unsgard G.
SonoWand, an ultrasound-based neuronavigation system.
Neurosurgery.
2000;
47
1373-1379
-
14
Gronningsaeter A, Unsgard G, Ommedal S, Angelsen BA.
Ultrasound-guided neurosurgery: a feasibility study in the 3-30 MHz frequency range.
Br J Neurosurg.
1996;
10
161-168
-
15
Hata N, Dohi T, Iseki H, Takakura K.
Development of a frameless and armless stereotactic neuronavigation system with ultrasonographic registration.
Neurosurgery.
1997;
41
608-613
-
16
Jodicke A, Springer T, Boker DK.
Real-time integration of ultrasound into neuronavigation: technical accuracy using a light-emitting-diode-based navigation system.
Acta Neurochir (Wien).
2004;
146
1211-1220
-
17
Lindseth F, Bang J, Lango T.
A robust and automatic method for evaluating accuracy in 3-D ultrasound-based navigation.
Ultrasound Med Biol.
2003;
29
1439-1452
-
18
Prager RW, Rohling RN, Gee AH, Berman L.
Rapid calibration for 3-D freehand ultrasound.
Ultrasound Med Biol.
1998;
24
855-869
-
19
Roche A, Pennec X, Malandain G, Ayache N.
Rigid registration of 3-D ultrasound with MR images: a new approach combining intensity and gradient information.
IEEE Trans Med Imaging.
2001;
20
1038-1049
-
20
Schlaier JR, Warnat J, Dorenbeck U, Proescholdt M, Schebesch KM, Brawanski A.
Image fusion of MR images and real-time ultrasonography: evaluation of fusion accuracy combining two commercial instruments, a neuronavigation system and a ultrasound system.
Acta Neurochir (Wien).
2004;
146
271-276
-
21
Renner C, Lindner D, Schneider JP, Meixensberger J.
Evaluation of intra-operative ultrasound imaging in brain tumor resection: a prospective study.
Neurol Res.
2005;
27
351-357
-
22
Comeau RM, Sadikot AF, Fenster A, Peters TM.
Intraoperative ultrasound for guidance and tissue shift correction in image-guided neurosurgery.
Med Phys.
2000;
27
787-800
-
23
Hernes TA, Ommedal S, Lie T, Lindseth F, Lango T, Unsgaard G.
Stereoscopic navigation-controlled display of preoperative MRI and intraoperative 3D ultrasound in planning and guidance of neurosurgery: new technology for minimally invasive image-guided surgery approaches.
Minim Invas Neurosurg.
2003;
46
129-137
-
24
Lindseth F, Lango T, Bang J, Nagelhus Hernes TA.
Accuracy evaluation of a 3D ultrasound-based neuronavigation system.
Comput Aided Surg.
2002;
7
197-222
-
25
Reinacher PC, van Velthoven V.
Intraoperative ultrasound imaging: practical applicability as a real-time navigation system.
Acta Neurochir.
2003;
85
((Suppl))
89-93
-
26
Jodicke A, Deinsberger W, Erbe H, Kriete A, Boker DK.
Intraoperative three-dimensional ultrasonography: an approach to register brain shift using multidimensional image processing.
Minim Invas Neurosurg.
1998;
41
13-19
-
27
Trantakis C, Tittgemeyer M, Schneider JP, Lindner D, Winkler D, Strauss G, Meixensberger J.
Investigation of time-dependency of intracranial brain shift and its relation to the extent of tumor removal using intra-operative MRI.
Neurol Res.
2003;
25
9-12
-
28
van Velthoven V.
Intraoperative ultrasound imaging: comparison of pathomorphological findings in US versus CT, MRI and intraoperative findings.
Acta Neurochir.
2003;
85
((Suppl))
95-99
-
29
Sure U, Benes L, Bozinov O, Woydt M, Tirakotai W, Bertalanffy H.
Intraoperative landmarking of vascular anatomy by integration of duplex and Doppler ultrasonography in image-guided surgery. Technical note.
Surg Neurol.
2005;
63
133-141
-
30
Letteboer MM, Willems PW, Viergever MA, Niessen WJ.
Brain shift estimation in image-guided neurosurgery using 3-D ultrasound.
IEEE Trans Biomed Eng.
2005;
52
268-276
-
31
Kanno H, Ozawa Y, Sakata K, Sato H, Tanabe Y, Shimizu N, Yamamoto I.
Intraoperative power Doppler ultrasonography with a contrast-enhancing agent for intracranial tumors.
J Neurosurg.
2005;
102
295-301
-
32
Coenen VA, Krings T, Weidemann J, Hans FJ, Reinacher P, Gilsbach JM, Rohde V.
Sequential visualization of brain and fiber tract deformation during intracranial surgery with three-dimensional ultrasound: an approach to evaluate the effect of brain shift.
Neurosurgery.
2005;
56
133-141
Correspondence
Dr. med. Dirk Lindner
Department of Neurosurgery·University of Leipzig
Liebigstraße 20
04103 Leipzig
Germany
Phone: +49/341/971 75 00
Fax: +49/341/971 75 09
Email: dlind@medizin.uni-leipzig.de
