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Intraoperative computed tomography with integrated navigation system in a multidisciplinary operating suite.

Eberhard Uhl¹, Stefan Zausinger, Dominik Morhard

¹Department of Neurosurgery, Klinikum Grosshadern, University of Munich, Munich, Germany. eberhard.uhl@ lkh- klu.at

|May 1, 2009

Summary

This study demonstrates the feasibility of integrating intraoperative computed tomography (CT) scanning with a frameless neuronavigation system (NNS) for improved surgical workflow and patient safety in neurosurgery. The combined system offers excellent image quality and can be implemented without altering existing surgical protocols.

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Area of Science:

Neurosurgery
Medical Imaging
Surgical Navigation

Background:

Intraoperative imaging is crucial for surgical guidance and confirmation.
Frameless neuronavigation systems (NNS) enhance surgical precision.
Integrating multislice computed tomography (CT) with NNS offers potential workflow and safety benefits.

Purpose of the Study:

To evaluate the feasibility, workflow, and image quality of a multislice CT scanner combined with a frameless NNS.
To assess the impact of intraoperative CT imaging on surgical outcomes and decision-making.
To determine the system's suitability for integration into existing operating room environments.

Main Methods:

A 40-slice CT scanner was integrated with an infrared-based frameless NNS in a standard operating room.
Automated image registration allowed real-time NNS updates.
A radiolucent operating table and head clamp facilitated patient positioning for intraoperative scanning.

Main Results:

Feasibility confirmed in 230 patients (136 cranial, 94 spinal).
Surgical interruption for intraoperative CT was limited (9-15 minutes).
Surgery course changed in 16 cases due to suboptimal screw placement or incomplete tumor resection; intraoperative CT angiography provided good image quality.

Conclusions:

The CT-NNS system is feasible in existing ORs without special instruments, enhancing safety.
Real-time imaging and NNS updates are possible with minimal workflow disruption.
Multidisciplinary use improves system utilization and cost-efficiency.