Computer-assisted Trajectory Planning in Neurosurgery
(Montag, 10.40 Uhr, Schinkelsaal)
Stereotactic surgery plays an important role in functional neurosurgery. Using electrodes implanted in specific parts of the brain deep brain stimulation (DBS) as most prominent example provides therapeutic benefits for patients with drug-resistant movement disorders such as Parkinson's disease, dystonia and essential tremor and affective disorders. Besides therapy stereotactic surgery also serves as diagnostic tool for example in patients with epilepsy to locate and define outlines of deep seated epileptogenic lesions for later on surgical resection (stereotactic electroencephalography, SEEG).
Stereotactic surgery requires precise planning of target positions and trajectories in a way risk structures such as vessels and ventricles are not hurt during implantation of the electrodes. In case of DBS most times one or two electrodes are used whereas in case of SEEG a lot more electrodes are implanted.
For each electrode to be implanted the surgeon has to define a target point and to locate a safe trajectory (avoiding vessels and ventricles as well as sulci in the entrance area) within a navigation system manually, which is a very time consuming step ranging from 10 to 45 minutes up to 1.5 hours like reported in literature.
To support the surgeons and to shorten time for definition of safe trajectories different computer-assisted approaches have been developed so far, up to now not yet applicable in clinical practice. Several methods use segmentation of risk structures like vessels or ventricles or prior knowledge from atlases and rule based methods to reduce the number trajectories to be evaluated by the surgeon. Other promising approaches define safety criteria such as image homogeneity to suggest safe trajectories to the surgeon.
Dr. Miriam Bauer
Universitätsklinikum Gießen/Marburg, Klinik für Neurochirurgie Marburg