Intraoperative imaging of the brain

Area of Science:

• Neurosurgery
• Medical Imaging
• Radiosurgery

Background:

• Computed imaging techniques have significantly advanced neurosurgical procedures.
• Over a 20-year period, intraoperative imaging was utilized in over 4,000 patient cases.
• Imaging tool selection is procedure-dependent in neurosurgery.

Purpose of the Study:

• To review the application and selection of intraoperative imaging modalities in neurosurgery.
• To highlight the evolving role of imaging in various neurosurgical interventions.
• To compare the efficacy of different imaging tools for specific procedures.

Main Methods:

• Retrospective analysis of over 4,000 neurosurgical cases utilizing intraoperative imaging.
• Categorization of imaging tool usage based on neurosurgical procedure type (transsphenoidal, spinal, functional, stereotactic, radiosurgery, vascular).
• Review of imaging modalities including intraoperative fluoroscopy, computed tomography (CT), magnetic resonance imaging (MRI), angiography, and digital subtraction angiography.

Main Results:

• Intraoperative fluoroscopy was used for transsphenoidal, spinal, and functional procedures.
• A dedicated intraoperative CT scanner supported over 1,500 stereotactic/image-guided procedures.
• Intraoperative MRI was identified as superior for radiosurgery, while CT remains key for stereotactic surgery.

Conclusions:

• Computed imaging has revolutionized neurosurgery, with specific tools chosen for different procedures.
• CT is the primary imaging tool for conventional image-guided stereotactic surgery.
• Intraoperative MRI is the preferred modality for radiosurgery, enhancing precision and safety.