Evaluate vascular structures and assessment of clipping immediately with intraoperative CTA. Please note the dorsally positioned radiotranslucent retractor, which can be left in place during the scanning procedure without causing artifacts to the images (Fig. The first examination is performed right before the screws are to be placed. The remaining 10 screws were classified sufficient regarding stability and position towards endangered anatomical structures. And in meningioma patients, the surgical field changes due to the drilling that needs to be done to remove this tumor, which can involve the adjacent bony region.” Using intraoperative CT allows the dataset for the neuronavigation system to be updated whenever necessary. in case of cervical instability) since any navigation on the basis of image sets obtained prior to the positioning of the patient on the OR table may be misleading. I am convinced that adoption of intraoperative CT will increase, and this is certainly in the interests not only of the patients but also of our hospital administrators.”. In the remaining case, the quality was rated insufficient for diagnostic evaluation due to major streak artefacts induced by the titanium pins of the head clamp. 1B). Surgeons at the University used intraoperative CT to visualize tumor tissue for resection that might otherwise have been missed without having images from intraoperative CT available for assessing the tumor resection success during surgery. The second advantage is that we can check the position of the implants immediately. Philipp Grätzel von Grätz |  Dynamic CT imaging allows them obtain functional information, beyond tissue morphology. Time needed for the stabilisation procedure (surgical exposure, registration of the spine, screw placement and intraoperative control-iCT) was 83.1 ± 22.4 min (2 screws) for transarticular C 1/2, 77.2 ± 24.1 min for lumbar (4 screws) and 102.7 ± 25.0 min (8 screws) for thoracic transpedicular screw placement Fig. Tonn explains that by reducing complications, the likelihood of a re-admission decreases, which means that the hospital saves money. Intraoperative microelectrode recording Microelectrode recording (MER) is used to confirm targeting accuracy during deep brain stimulation (DBS) surgery. This technology also makes more complex surgeries safer and shorter in duration. After final positioning of the patient according to the envisioned procedure, a “safety check” was performed, and the optimal scanning position of the operating table is saved in a computer panel at the wall allowing exact automatic repositioning for intraoperative imaging during surgery. In order to avoid artefacts in cranial surgery, optimal fixation of the pins of the radiolucent head clamp is of major importance and can require considerable time in some cases. There was no increase of infection rate or other procedure-related morbidity compared to patients from the pre-iCT era. The OR table is moved automatically to the initially saved position using the remote control. The BrainLab Airo Mobile Intraoperative CT scanner system is a mobile imaging platform that can be used during surgery to obtain a high-resolution CT scan of a patient while in the operating room undergoing surgery. Hereby, the real position of the spine during surgery is the basis for navigation. “The only difference is that, in our setup, the two CTs are taken intraoperatively,” says Zausinger. According to Professor Stefan Zausinger, MD, Department of Neurosurgery, University Hospital Grosshadern, Munich, these spinal instabilities mostly affect patients with degenerative diseases of the spine: “But we also see patients with traumatic spinal injuries and with spinal instabilities as a result of malignant tumors.”. ± 0.1 mm could be achieved. Intraoperative CT angiography and normal perfusion CT after clipping of a right-sided MCA aneurysm. Hereby the gantry is moved over the patient in order to detect any possible collision during the scanning procedure. The challenge with spinal fusion is that the screws need to be placed as accurately as possible for two reasons, as Zausinger points out: “Malpositioning of the implants can cause damage to the nerve roots or to the spinal cord, or to some vessels adjacent to the spinal cord. Perfusion scanning started 5 s after injection of 50 ml contrast agent (Imeron 300) at 7 ml/s and a saline flush of 50 ml at 7 ml/s. Intraoperative CT scan provides clinical benefit in technically difficult cases and has a smooth workflow. Philipp Grätzel von Grätz, MD is a medical doctor turned freelance writer and book author based in Berlin, Germany. There was no collision of the patient and the scanner or any new neurological deficit or infection related to the intraoperative scanning. for shunt surgery), allowing navigated positioning and immediate control of position of the catheter and replacement, if necessary. Enter the Airo Mobile Intraoperative CT system—a portable, high-definition imaging system that has redefined our neurosurgical processes. After placement of the screws, an intraoperative control-CT scan is performed. An intraoperative CT was obtained to assess the extent of decompression and the accuracy of instrumentation. Tonn, Schichor, Zausinger, and their colleagues have gathered data from several prospective patient series in order to better analyze these benefits scientifically. And conventional angiography tells us nothing about distant brain perfusion.” Looking back, Schichor recalls several patients in whom the surgeon who performed the clipping was convinced that he had occluded the aneurysm. When using intraoperative CT, he looks specifically at CT angiography and CT perfusion scans: “In CT angiography, we see whether the vessel patency is preserved. And with CT perfusion scans, we can have a look at the distant perfusion in order to evaluate whether the clipping has some detrimental effect on other brain regions.”. The specific benefits of intraoperative CT are best illustrated with typical patient scenarios. In aneurysm surgery, there is no navigation. Screw position can now be proved by intraoperative CT images during the procedure and can be corrected immediately if necessary. Keywords: Intraoperative computed tomography scan, Image-guided neurosurgery, Glioma surgery, Spine surgery, Multiloculated hydrocephalus, Third ventricular colloid cyst All that has to be done is to place a reference star at a spinous process. The benefits of intraoperative CT in spinal fusion come without additional radiation exposure: A CT examination before surgery has to be carried out anyway. In 65/414 of the screws (15.7 %) we detected a minor pedicle perforation <2 mm. The O-arm intraoperative CT imaging and navigation system allows Inland Neurosurgery Institute’s experienced neurosurgeons to visualize your anatomy in 3D during the operation, resulting in increased surgical precision, smaller incisions, and improved outcomes. “We also had one patient in whom a large aneurysm was pressing the clip downwards toward the vessel. In addition, in case of patients with tumorous disease, the extent of tumour resection could be confirmed. Time for intraoperative scans in cranial surgery depends mainly on whether application of contrast media is needed which requires additional time. In low-grade gliomas iCT has to be refined further due to the low soft-tissue contrast. We can see during surgery whether the screws or the rods are compressing any structure, and we also see hematomas right away.” Should a problem be identified, it can be corrected immediately. It is a dual-room solution that is mounted on rails in-between two operating theaters, separated by two sliding doors, so that the CT can be used by surgeons in both rooms.

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