Intraoperative Integration of Multimodal Imaging to Improve Neuronavigation: A Technical Note

Area of Science:

• Neurosurgery
• Medical Imaging
• Image-Guided Surgery

Background:

• Brain shift during surgery can lead to significant neuronavigation errors.
• Intraoperative MRI is reliable for brain tumor surgery but is costly and limited in availability.
• Accurate navigation is crucial for minimizing surgical mistakes.

Purpose of the Study:

• To describe a surgical workflow integrating preoperative MRI with intraoperative imaging and image fusion.
• To compensate for surgically induced brain shift in brain tumor surgery.
• To evaluate the feasibility of intraoperative navigation updates.

Main Methods:

• A case series of 4 brain tumor patients utilizing neuronavigation with preoperative MRI.
• Integration of intraoperative computed tomography (CT) and ultrasound (US) scans.
• Application of rigid and elastic image fusion between preoperative MRI and intraoperative data using specialized software.

Main Results:

• Successful integration of various intraoperative imaging components was demonstrated in four cases.
• Intraoperative navigation updates were feasible using 3D US and CT scanning.
• The degree of brain shift influenced the choice between rigid and elastic image fusion.

Conclusions:

• Combining multiple intraoperative imaging techniques with image fusion may reduce neuronavigation errors in brain tumor resection.
• This approach can potentially mitigate risks associated with brain shift.
• Further research with larger patient cohorts is necessary to validate these findings.