Combined Image Guidance and Intraoperative Computed Tomography in Facilitating Endoscopic Orientation within and around the Paranasal Sinuses

Background The utility of image guidance (image-guided surgery [IGS]) and intraoperative computed tomography (CT) scanning as a tool for less experienced endoscopic surgeons to aid in localization of paranasal sinus and skull base anatomic structures was evaluated. Methods Partial endoscopic dissection was performed on cadaver specimens by three fellowship trained rhinologists. Anatomic sites within and around the sinuses were tagged with radio-opaque markers. Otolaryngology residents identified tagged anatomic sites using four successive levels of technology: endoscopy alone (simulating outpatient clinic), endoscopy plus preoperative CT (simulating endoscopic sinus surgery [ESS] without IGS), endoscopy plus IGS registered to preoperative CT (simulating current ESS with IGS), and endoscopy plus IGS registered to real-time intraoperative CT. Responses were graded as follows: consensus rhinologist answer (4 points), close answer without clinically significant difference (3 points), within anatomic region but definite clinical difference (2 points), outside of anatomic region (1 point), no answer (0 points). Results Eleven residents participated. Of 20 specific anatomic sites, IGS-intraoperative CT provided the most accurate anatomic identification at 16 sites. For 8 sites, IGS-intraoperative CT had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.29-0.67). For 6 sites, IGS-preoperative CT scan had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.30-0.67). All participants found that IGS-intraoperative CT scan made them most comfortable in identifying anatomy. Conclusion Combined IGS and intraoperative CT scan technology may be an instructional adjunct for less experienced paranasal sinus surgeons for dissection and evaluation of unfamiliar or distorted anatomy.

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Association Between Intraoperative Computed Tomography Navigation System and Incidence of Surgical Site Infection in Patients with Spinal Surgeries: A Retrospective Analysis

10.21203/rs.3.rs-754286/v1 ◽

2021 ◽

Author(s):

GENTARO KUMAGAI ◽

Kanichiro Wada ◽

Sunao Tanaka ◽

Toru Asari ◽

Yohshiro Nitobe ◽

...

Keyword(s):

Computed Tomography ◽

Navigation System ◽

Odds Ratio ◽

Intraoperative Imaging ◽

Clinical Status ◽

Japanese Orthopaedic Association ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Intraoperative Fluoroscopy ◽

Significant Difference

Abstract Purpose: Although the use of intraoperative computed tomography (CT)-based navigation systems is unlikely to cause intraoperative contamination more than the use of intraoperative fluoroscopy, the association between intraoperative CT/navigation and surgical site infections (SSIs) remains unclear. We investigated the incidence of SSIs and the association between intraoperative CT/navigation and SSIs for spinal surgeries.Methods: Of the 512 patients who underwent spinal surgery between April 2016 and December 2020, 304 underwent C-arm intraoperative fluoroscopy and/or Medtronic O-arm intraoperative CT/navigation system. We investigated the incidence of SSIs in patients with four techniques; no intraoperative imaging C-arm only, O-arm only, and both O- and C-arm used. Multivariate logistic analyses were conducted using the prevalence of SSIs as the dependent variable. The independent variables were age, sex, and potential confounders including preoperative Japanese Orthopaedic Association (JOA) score, use of instrumentation, C-arm and/or O-arm. Results: The incidence of the SSIs in patients with no imaging, C-arm only, O-arm only, and both modalities used was 1.9％, 7.3%, 4.7%, and 8.3%, respectively. There was no significant difference in the incidence of SSIs between the four techniques. Multivariate logistic analyses showed a significant correlation between the prevalence of SSI and JOA scores (odds ratio, 0.878; 95%CI, 0.759-0.990) and use of instrumentation (odds ratio, 6.241; 95%CI, 1.113-34.985), but not use of O-arm.Conclusions: The incidence of the SSIs in patients with only O-arm used was 4.7%. Preoperative clinical status and use of instrumentation, but not use of the O-arm, was associated with SSIs after spinal surgeries.

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Preoperative Magnetic Resonance and Intraoperative Computed Tomography Fusion for Real-Time Neuronavigation in Intramedullary Lesion Surgery

Operative Neurosurgery ◽

10.1093/ons/opw005 ◽

2016 ◽

Vol 13 (2) ◽

pp. 188-195 ◽

Cited By ~ 1

Author(s):

Francesco Costa ◽

Alessandro Ortolina ◽

Andrea Cardia ◽

Marco Riva ◽

Martina Revay ◽

...

Keyword(s):

Computed Tomography ◽

Magnetic Resonance ◽

Ct Scan ◽

Real Time ◽

Ct Scanning ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Intramedullary Lesion ◽

Preoperative Magnetic Resonance ◽

Dural Opening

Abstract BACKGROUND: Image-guided surgery techniques in spinal surgery are usually based upon fluoroscopy or computed tomography (CT) scan, which allow for a real-time navigation of bony structures, though not of neural structures and soft tissue remains. OBJECTIVE: To verify the effectiveness and efficacy of a novel technique of imaging merging between preoperative magnetic resonance imaging (MRI) and intraoperative CT scan during removal of intramedullary lesions. METHODS: Ten consecutive patients were treated for intramedullary lesions using a navigation system aid. Preoperative contrast-enhanced MRI was merged in the navigation software, with an intraoperative CT acquisition, performed using the O-armTM system (Medtronic Sofamor Danek, Minneapolis, Minnesota). Dosimetric and timing data were also acquired for each patient. RESULTS: The fusion process was achieved in all cases and was uneventful. The merged imaging information was useful in all cases for defining the exact area of laminectomy, dural opening, and the eventual extension of cordotomy, without requiring exposition corrections. The radiation dose for the patients was 0.78 mSv. Using the authors’ protocol, it was possible to merge a preoperative MRI with navigation based on intraoperative CT scanning in all cases. Information gained with this technique was useful during the different surgical steps. However, there were some drawbacks, such as the merging process, which still remains partially manual. CONCLUSION: In this initial experience, MRI and CT merging and its feasibility were tested, and we appreciated its safety, precision, and ease.

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The Use of Skin Staples as Fiducial Markers to Confirm Intraoperative Spinal Navigation Registration and Accuracy

Operative Neurosurgery ◽

10.1093/ons/opab132 ◽

2021 ◽

Author(s):

Christopher Alvarez-Breckenridge ◽

Matthew Muir ◽

Laurence D Rhines ◽

Claudio E Tatsui

Keyword(s):

Minimally Invasive ◽

Ct Scan ◽

Image Guidance ◽

Low Cost ◽

Spinal Instrumentation ◽

Fiducial Marker ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Skin Staples ◽

Spinal Navigation

Abstract BACKGROUND With the advent of intraoperative computed tomography (CT) for image guidance, numerous examples of accurate navigation being applied to cranial and spinal pathology have come to light. For spinal disorders, the utilization of image guidance for the placement of percutaneous spinal instrumentation, complex osteotomies, and minimally invasive approaches are frequently utilized in trauma, degenerative, and oncological pathologies. The use of intraoperative CT for navigation, however, requires a low target registration error that must be verified throughout the procedure to confirm the accuracy of image guidance. OBJECTIVE To present the use of skin staples as a sterile, economical fiducial marker for minimally invasive spinal procedures requiring intraoperative CT navigation. METHODS Staples are applied to the skin prior to obtaining the registration CT scan and maintained throughout the remainder of the surgery to facilitate confirmation of image guidance accuracy. RESULTS This low-cost, simple, sterile approach provides surface landmarks that allow reliable verification of navigation accuracy during percutaneous spinal procedures using intraoperative CT scan image guidance. CONCLUSION The utilization of staples as a fiducial marker represents an economical and easily adaptable technique for ensuring accuracy of image guidance with intraoperative CT navigation.

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The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.186977 ◽

2016 ◽

Vol 7 (04) ◽

pp. 598-602 ◽

Cited By ~ 10

Author(s):

Stefan Linsler ◽

Sebastian Antes ◽

Sebastian Senger ◽

Joachim Oertel

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Skull Base ◽

Imaging Data ◽

Navigation Surgery ◽

Ct Guided ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Resection Control ◽

Special Cases

ABSTRACT Objective: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. Materials and Methods: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated. In this case, we performed an endonasal transsphenoidal approach for debulking the adenoma and for chiasma decompression. We used an MRI neuronavigation (Medtronic Stealth Air System) which was registered via intraoperative CT scan (Siemens CT Somatom). Preexisting MRI studies (navigation protocol) were fused with the intraoperative CT scans to enable three-dimensional navigation based on MR and CT imaging data. Intraoperatively, we did a further CT scan for resection control. Results: The intraoperative accuracy of the neuronavigation was excellent. There was an adjustment of <1 mm. The navigation was very helpful for orientation on the destroyed skull base in the sphenoid sinus. After opening the sellar region and tumor debulking, we did a CT scan for resection control because the extent of resection was not credible evaluable in this huge infiltrating adenoma. Thereby, we were able to demonstrate a sufficient decompression of the chiasma and complete resection of the medial part of the adenoma in the intraoperative CT images. Conclusions: The use of intraoperative CT/MRI-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique for special cases.

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Role of intraoperative computed tomography scanner in modern neurosurgery – An early experience

Surgical Neurology International ◽

10.25259/sni_303_2020 ◽

2020 ◽

Vol 11 ◽

pp. 247

Author(s):

Mohammad Ashraf ◽

Nabeel Choudhary ◽

Syed Shahzad Hussain ◽

Usman Ahmad Kamboh ◽

Naveed Ashraf

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

External Ventricular Drain ◽

Colloid Cyst ◽

Ventricular Catheter ◽

Low Grade ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Multiloculated Hydrocephalus ◽

Wide Range

Background: Intraoperative imaging addresses the limitations of frameless neuronavigation systems by providing real-time image updates. With the advent of new multidetector intraoperative computed tomography (CT), soft tissue can be visualized far better than before. We report the early departmental experience of our intraoperative CT scanner’s use in a wide range of technically challenging neurosurgical cases. Methods: We retrospectively analyzed the data of all patients in whom intraoperative CT scanner was utilized. Out of 31 patients, 24 (77.4%) were cranial and 8 (22.6%) spinal cases. There were 13 male (41.9%) and 18 (58.1%) female patients, age ranged from 1 to 83 years with a mean age of 34.29 years ±17.54 years. Seven patients underwent spinal surgery, 2 cases were of orbital tumors, and 16 intra-axial brain tumors, including 5 low- grade gliomas, 10 high-grade gliomas, and 1 colloid cyst. There were four sellar lesions and two multiloculated hydrocephalus. Results: The intraoperative CT scan guided us to correct screw placement and was crucial in managing four complex spinal instabilities. In intracranial lesions, 59% of cases were benefitted due to intraoperative CT scan. It helped in the precise placement of ventricular catheter in multiloculated hydrocephalus and external ventricular drain for a third ventricular colloid cyst. Conclusion: Intraoperative CT scan is safe and logistically and financially advantageous. It provides versatile benefits allowing for safe and maximal surgery, requiring minimum changes to an existing neurosurgical setup. Intraoperative CT scan provides clinical benefit in technically difficult cases and has a smooth workflow.

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Evaluation of Tarsal Navicular Stress Fracture Fixation Using Intraoperative O-arm Computed Tomography

Foot & Ankle Specialist ◽

10.1177/1938640014532130 ◽

2014 ◽

Vol 7 (6) ◽

pp. 515-521 ◽

Cited By ~ 4

Author(s):

Andrew R. Hsu ◽

Simon Lee

Keyword(s):

Computed Tomography ◽

Stress Fracture ◽

Guide Wire ◽

Weight Bearing ◽

Fracture Site ◽

Stress Fractures ◽

Functional Impairments ◽

Intraoperative Ct ◽

Intraoperative Computed Tomography ◽

Anatomic Reduction

Stress fractures of the tarsal navicular are high-risk injuries that can result in displacement, avascular necrosis, malunion, and nonunion. Delayed diagnosis and improper treatment can lead to long-term functional impairments and poor clinical outcomes. Increased shear stress and decreased vascularity in the central third of the navicular can complicate bony healing with often unpredictable return times to activity using conservative management in a non-weight-bearing cast. There recently has been increasing debate regarding the effectiveness of treatment options with a trend toward surgical management to anatomically reduce and stabilize navicular stress fractures in athletes. However, anatomic reduction and fixation of the navicular can be difficult despite direct visualization and intraoperative fluoroscopy. We report a case of a chronic navicular stress fracture in a high-level teenage athlete treated with open reduction internal fixation (ORIF) and calcaneus autograft using intraoperative computed tomography (CT) (O-arm®, Medtronic, Minneapolis, MN) for real-time evaluation of fracture reduction and fixation. Intraoperative CT was fast, reliable, and allowed for confirmation of guide wire orientation, alignment, and length across the fracture site. Anatomic fixation of navicular stress fractures can be challenging, and it is important for surgeons to be aware of the potential advantages of using intraoperative CT when treating these injuries. Levels of Evidence: Therapeutic, Level IV: Case Report

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Endoscopic Visualization of the True Maxillary Ostium Following Uncinectomy

Ear Nose & Throat Journal ◽

10.1177/0145561319853260 ◽

2019 ◽

Vol 99 (6) ◽

pp. 384-387 ◽

Cited By ~ 1

Author(s):

Omar H. Ahmed ◽

Marissa P. Lafer ◽

Ilana Bandler ◽

Elcin Zan ◽

Binhuan Wang ◽

...

Keyword(s):

Computed Tomography ◽

Retrospective Study ◽

Chronic Rhinosinusitis ◽

Study Design ◽

Endoscopic Sinus Surgery ◽

Nasolacrimal Duct ◽

Sinus Surgery ◽

Academic Hospital ◽

Preoperative Ct

Objectives: To examine the frequency in which angled endoscopes are necessary to visualize the true maxillary ostium (TMO) following uncinectomy and prior to maxillary antrostomy. Additionally, to identify preoperative computed tomography (CT) measures that predict need for an angled endoscope to visualize the TMO. Study Design: Retrospective study. Setting: Tertiary academic hospital. Patients and Methods: Patients who underwent endoscopic sinus surgery (ESS) between December of 2017 and August of 2018 were retrospectively identified. Cases were reviewed if they were primary ESS cases for chronic rhinosinusitis without polyposis and if they were at least 18 years of age. Results: Sixty-three maxillary antrostomies were reviewed (82.5% were from bilateral cases). Thirty-five cases (55.6%) required an angled endoscope in order to visualize the TMO. Of the preoperative CT measures examined, a smaller sphenoid keel-caudal septum-nasolacrimal duct (SK-CS-NL) angle was significantly associated with need for an angled endoscope intraoperatively to visualize the TMO (17.1° SD ± 3.2 vs 15.0° SD ± 2.9; P = .010). Conclusion: Angled endoscopes are likely required in the majority of maxillary antrostomies to visualize the TMO. This is important to recognize in order to prevent iatrogenic recirculation. The SK-CS-NL angle may help to identify cases preoperatively which require an angled endoscope to identify the TMO during surgery.

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The impact of pre-operative computed tomography scan in patients underwent septoplasty on the postoperative complications

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20211001 ◽

2021 ◽

Author(s):

Abdulwahid S. AlQahtani ◽

Ramzi M. Dagriri ◽

Radeif E. Shamakhi ◽

Ahmad M. Alrasheed ◽

Ahmed A. Etwadi ◽

...

Keyword(s):

Computed Tomography ◽

Postoperative Complications ◽

Paranasal Sinus ◽

Nasal Obstruction ◽

Computed Tomography Scan ◽

Gold Standard Method ◽

External Nose ◽

Preoperative Ct ◽

The Impact ◽

Tomography Scan

Background: Deviated nasal septum (DNS) is one of the most frequent causes of nasal obstruction in adults. An anterior rhinoscopy (AR), which is usually the first diagnostic procedure in the evaluation of obstructive nasal pathologies, is often inadequate in the assessment of the posterior nasal cavity and the gold standard method for the evaluation of paranasal anatomy and inflammatory paranasal sinus pathologies is paranasal sinus computed tomography (PNS CT). Aim was to validate the recommendation of pre-operative computed tomography scan in minimizing post-septoplasty complications.Methods: A retrospective record based study was conducted including all patients with clinically diagnosed DNS and undergone surgical intervention at Khamis Mushayet General Hospital. Data extracted included patients demographic data, and post-operative recorded complications and history of preoperative CT scan for evaluating and grading DNS. Results: A total sample of 60 patients’ undergone septoplasty for DNS. Patients who undergone preoperative CT were 30. The remaining 30 patients didn’t undergone pre-operative CT for evaluation of DNS. The most diagnosed complication was nasal obstruction (28.3%) followed by external nose deformity (20%). Exact of 47% of patients had postoperative nasal obstruction didn’t undergone pre-operative CT. About 42% of those who had postoperative nasal deformity didn’t undergone CT while 33% of patient who had post-operative bleeding and septal perforation didn’t undergone CT.Conclusions: In conclusion, the study revealed that preoperative CT showed insignificant efficacy in relieving nasal obstruction or minimizing postoperative complications.

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Treatment of fresh thoracolumbar vertebral burst fracture based on intraoperative CT scan

10.21203/rs.3.rs-21232/v1 ◽

2020 ◽

Author(s):

yuwei li ◽

wei cui ◽

Peng Zhou ◽

Cheng Li ◽

Wei Xiao ◽

...

Keyword(s):

Treatment Group ◽

Ct Scan ◽

Cobb Angle ◽

Dura Mater ◽

Spinal Canal ◽

Control Group ◽

Intraoperative Ct ◽

Bleeding Volume ◽

Significant Difference ◽

Cord Injury

Abstract ObjectiveTo evaluate the value of intraoperative CT scanning in the treatment of fresh thoracolumbar burst fractures .MethodThe data of patients with thoracolumbar fractures from January 2008 to January 2015 were analyzed retrospectively,79 cases were treatment group which were treated with intraoperative CT scan and decompression mode was determined according to CT scan results during the period from October 2012 to January 2015; 82 patients as the observation group were treated without intraoperative CT scan and direct laminectomy were performed during the period from January 2008 to October 2012. In the treatment group, it is no further decompression of the spinal canal when the CT showed a reduction of the fracture block into the spinal canal, If the intraoperative CT showed that the fractures still occupied the spinal dura mater according to the three-dimensional CT information, The position and the size of the fracture of the spinal canal were determined, and the unilateral laminectomy was performed corresponding to the position of the lamina and intervertebral ligamentum flavum. The operative time, bleeding volume, neurological function, height of the anterior vertebral compression and Cobb angle were compared between the two groups.ResultIn the treatment group, CT scan showed 48 cases (60.8%) entered the spinal canal fracture completely or basically reset .31 cases (39.2%) still occupied the spinal canal compression spinal dura mater. There were significant differences in the operation time and bleeding volume between the two groups. The treatment group was less than the control group. There was no infection, secondary spinal cord injury, loose fixation and other complications. There was no difference in the ASIA classification before and after operation. The anterior vertebral height and COBB angle of the two groups were significantly improved compared with those before operation. There was no significant difference between the two groups in the postoperative height and COBB angle, but after 2 years the difference was statistically significant between the two groups, to retain the rear ligament complex treatment group was significantly better than the control group.ConclusionPatients of thoracolumbar vertebral fracture in hyperextension position combined with internal fixation can achieve good correction effect. Orthopedic postoperative CT scan and according to the results of the scan precision treatment can simplify the operation, there was no difference in clinical efficacy compared with total laminectomy, but some patients avoid the spinal canal decompression and part were treated by small fenestration laminectomy decompression, which is conducive to the protection of spinouts ligament complex integrity.

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Evaluation of version of acetabular component following total hip replacement on conventional radiograph and computed tomography

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720942887 ◽

2020 ◽

Vol 27 (2) ◽

pp. 179-185

Author(s):

Manish Raj ◽

Ashish Jaiman ◽

Rajesh Kumar Chopra

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Total Hip Replacement ◽

Gold Standard ◽

Hip Replacement ◽

Regression Line ◽

Patient Positioning ◽

Acetabular Version ◽

Total Hip ◽

Significant Difference

Background/Purpose: Total hip replacement (THR) is considered as one of the most successful orthopedic procedures. However, improperly placed components can lead to instability and accelerated wear. Acetabular cup inclination can be very well accessed by anteroposterior pelvis X-rays; for acetabular version assessment, computed tomography (CT) scan is the gold standard. CT scan is not readily available at many centers and the surgeon has to rely on X-ray methods for evaluation of acetabular version to audit results and to predict behavior of the surgical intervention. This prospective study was undertaken to compare Woo and Morrey’s and ischiolateral methods of assessment of acetabular version on cross-table lateral radiographs with CT assessment and to assess the validity of radiographic methods with respect to CT scan method. Material and methods: A prospective follow-up study was conducted for 18 months’ duration (October 2016 to March 2018) on 30 adult patients who underwent THR surgery. Cross-table lateral radiograph was obtained at 3 and 6 weeks in the postoperative period. Two observers made each observation at two different points of time. CT scan was performed at 3 weeks. Version as measured by radiographs and CT scan was recorded. Results: The major overlap in the distribution of the values of the Woo and Morrey method suggests that there is no significant difference between the observations. Distribution of the values of the ischiolateral view and the CT scan value distributions have a very small overlap and hence suggest a strong significant difference between the two. Conclusion: In this study, Woo and Morrey’s method and ischiolateral method of assessment of acetabular version were compared with CT assessment. We found that in Woo and Morrey’s method, values were comparable to CT scan values, when put on regression line. However, in situation of change in patient positioning, namely hip stiffness in contralateral hip, measurement of component changed in series of radiography due to differences in pelvis tilt. So, in these circumstances, we can use ischiolateral method which can give consistent measurement. But it will not be in concordance with CT scan values and Woo and Morrey values, as represented in regression line. The high intra-class correlation coefficients for both intra- and inter-observer reliability indicated that the angle measured with these methods is consistent and reproducible for multiple observers. CT, however, be considered as gold standard for measurement owing to control over pelvic rotation and/or tilt/patient positioning.

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