Intraoperative brain shift and deformation: a quantitative analysis of cortical displacement in 28 cases.
OBJECTIVE
A quantitative analysis of intraoperative cortical shift and deformation was performed to gain a better understanding of the nature and extent of this problem and the resultant loss of spatial accuracy in surgical procedures coregistered to preoperative imaging studies.


METHODS
Three-dimensional feature tracking and two-dimensional image analysis of the cortical surface were used to quantify the observed motion. Data acquisition was facilitated by a ceiling-mounted robotic platform, which provided a number of precision tracking capabilities. The patient's head position and the size and orientation of the craniotomy were recorded at the start of surgery. Error analysis demonstrated that the surface displacement measuring methodology was accurate to 1 to 2 mm. Statistical tests were performed to examine correlations between the amount of displacement and the type of surgery, the nature of the cranial opening, the region of the brain involved, the duration of surgery, and the degree of invasiveness.


RESULTS
The results showed that a displacement of an average of 1 cm occurred, with the dominant directional component being associated with gravity. The mean displacement was determined to be independent of the size and orientation of the cranial opening.


CONCLUSIONS
These data suggest that loss of spatial registration with preoperative images is gravity-dominated and of sufficient extent that attention to errors resulting from misregistration during the course of surgery is warranted.
Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
D W
DW
Roberts
A
A
Hartov
F E
FE
Kennedy
M I
MI
Miga
K D
KD
Paulsen
D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000601:surgery; D001931:Brain Mapping / Q000295:instrumentation*; D001932:Brain Neoplasms / Q000601:surgery; D002540:Cerebral Cortex / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D007431:Intraoperative Complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009038:Motion; D012371:Robotics