Abstract

Purpose Minimal invasion computer-assisted neurosurgical procedures with various tool insertions into the brain may carry hemorrhagic risks and neurological deficits. The goal of this study is to investigate the role of computer-based surgical trajectory planning tools in improving the potential safety of image-based stereotactic neurosurgery.

Methods Multi-sequence MRI studies of eight patients who underwent image-guided neurosurgery were retrospectively processed to extract anatomical structures—head surface, ventricles, blood vessels, white matter fibers tractography and fMRI data of motor, sensory, speech, and visual areas. An experienced neurosurgeon selected one target for each patient. Five neurosurgeons planned a surgical trajectory for each patient using three planning methods: (1) conventional; (2) visualization, in which scans are augmented with overlays of anatomical structures and functional areas; and (3) automatic, in which three surgical trajectories with the lowest expected risk score are automatically computed. For each surgeon, target, and method, we recorded the entry point and its surgical trajectory and computed its expected risk score and its minimum distance from the key structures.

Results A total of 120 surgical trajectories were collected (5 surgeons, 8 targets, 3 methods). The surgical trajectories expected risk scores improved by 76% (SD = 11.6 %; p < 0.05, two-sample student’s t test); the average distance of a trajectory from nearby blood vessels increased by 1.6 mm (SD = 0.5, p < 0.05) from 0.6 to 2.2 mm (243%). The initial surgical trajectories were changed in 85% of the cases based on the expected risk score and the trajectory distance from blood vessels.

Conclusions Computer-based patient-specific preoperative planning of surgical trajectories that minimize the expected risk of vascular and neurological damage due to incorrect tool placement is a promising technique that yields consistent improvements.

The role of automatic computer-aided surgical trajectory planning in improving the expected safety of stereotactic neurosurgery
Miri Trope
Miri Trope
School of Engineering and Computer Science, The Hebrew University of Jerusalem, Givat Ram Campus, 91904 Jerusalem, Israel
Reuben R. Shamir
Reuben R. Shamir
School of Engineering and Computer Science, The Hebrew University of Jerusalem
Phone +972-77-200-5991
Second email: shamir.ruby@gmail.com

Computer Aided Medical Procedures, Technische Universität München, Germany

The Edmond and Lily Safra Center for Brain Research (ELSC)

Center for Functional and Restorative
Neurosurgery, Department of Neurosurgery, Hadassah University Hospital, Ein-Karem, Jerusalem , Israel
Leo Joskowicz
Leo Joskowicz
School of Computer Science and Engineering, Computer-Aided Surgery and Medical Image Processing Laboratory, The Hebrew University of Jerusalem, Givat Ram Campus, Jerusalem 91904, Israel
Tel : +972-2-658-6299, Fax : +972-2-658-6459

The Edmond and Lily Safra Center for Brain Research (ELSC)
Z. Medress
Z. Medress
School of Medicine, Stanford University, Palo Alto, CA, USA

Department of Neurosurgery, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel
G. Rosenthal
G. Rosenthal
Department of Neurosurgery, Hadassah University Hospital, Ein-Karem, Jerusalem, Israel
A. Mayer
A. Mayer
fMRI Unit, Department of Neuroradiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
N. Levin
N. Levin
fMRI Unit, Department of Neuroradiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
A. Bick
A. Bick
fMRI Unit, Department of Neuroradiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
Yigal Shoshan
Yigal Shoshan
Department of Neurosurgery, School of Medicine, Hadassah University Hospital, Jerusalem, Israel