title: Intraoperative Iso-C C-arm navigation in craniospinal surgery: the first 60 cases.
abstract: OBJECTIVE
  The intraoperative Iso-C C-arm (Siremobil Iso-C 3D; Siemens Medical Solutions, Erlangen, Germany) provides a unique ability to acquire and view multiplanar three-dimensional images of intraoperative anatomy. Registration for intraoperative surgical navigation may be automated, thus simplifying the operative workflow.
  
  
  METHODS
  Iso-C C-arm intraoperative fluoroscopy acquires 100 images, each of which must be 1.8 degrees in a circumferential fashion about an "isocentric" point in space. The system generates a high-resolution isotropic three-dimensional data set that is available immediately after the 90-second C-arm rotation. The data set is ported to the image-guided workstation, registration is immediate and automated, and the surgeon can navigate with millimetric accuracy. The authors prospectively examined data from the initial 60 patients examined with the Iso-C, among whom were cases of anterior and posterior spinal instrumentation from the occiput to the sacrum. Percutaneous and minimally invasive spinal and cranial procedures were also included.
  
  
  RESULTS
  Automated registration for image-guided navigation was attainable for anterior and posterior cases from the cranial base and entire spine. In most cases, intraoperative postprocedural imaging with the Iso-C mitigated the need for postoperative imaging.
  
  
  CONCLUSIONS
  Intraoperative Iso-C three-dimensional scanning allows real-time feedback during cranial base and spinal surgery and during procedures involving instrumentation. In most cases, it obviates the need for postoperative computed tomography. Its usefulness is in its simplicity, and it can be easily adapted to the operating room workflow. When coupled with intraoperative navigation, this new technology facilitates complex neurosurgical procedures by improving the accuracy, safety, and time of surgery.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Hott
authors.forename: Vivek R
authors.initials: VR
authors.lastname: Deshmukh
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Klopfenstein
authors.forename: Volker K H
authors.initials: VK
authors.lastname: Sonntag
authors.forename: Curtis A
authors.initials: CA
authors.lastname: Dickman
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Papadopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001847:Bone Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation; D006801:Humans; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation*; D015203:Reproducibility of Results; D019291:Skull Base / Q000601:surgery*; D013131:Spine / Q000601:surgery*; D014057:Tomography, X-Ray Computed