title: Intraorbital access using fluoroscopic flat panel detector CT navigation and three-dimensional MRI overlay.
abstract: BACKGROUND
  Flat panel detector CT (FD-CT), three-dimensional image overlay and navigation software on contemporary fluoroscopic units generate less radiation dose while performing imaging of comparable quality to conventional CT. They can superimpose MR and CT datasets and can accurately guide percutaneous procedures providing live instrument visualization and the capability of re-imaging without patient transfer. These techniques, however, have been minimally used for accessing the head.
  
  
  METHODS
  Using an Allura Xper FD20 unit (Philips Healthcare Andover, Massachusetts, USA), three-dimensional image overlay and FD-CT navigation were used for percutaneous n-butyl cyanoacrylate (nBCA) embolization of an intraorbital mass in a 69-year-old man.
  
  
  RESULTS
  Three-dimensional image overlay provides accurate anatomical relationships between the optic nerve and vascular portions of the mass. Percutaneous nBCA was technically successful without non-target embolization and with no significant bleeding encountered during operative resection.
  
  
  CONCLUSIONS
  FD-CT navigation and three-dimensional image overlay provide accurate instrument guidance and spatial resolution comparable with current neuro-navigation systems while also providing real time instrument position and the ability to re-image without moving the patient. These are features not available with other types of neuro-navigation.
authors: University of Washington School of Medicine, Departments of Radiology and Neurological Surgery, Seattle, Washington 98195-7115, USA. dcooke@uw.edu
authors: Daniel L
authors: DL
authors: Cooke
authors: Michael
authors: M
authors: Levitt
authors: Louis J
authors: LJ
authors: Kim
authors: Danial K
authors: DK
authors: Hallam
authors: Basavaraj
authors: B
authors: Ghodke
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D004621:Embolization, Therapeutic / Q000379:methods; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods; D053783:Magnetic Resonance Imaging, Interventional / Q000295:instrumentation / Q000379:methods*; D008297:Male; D009915:Orbit / Q000000981:diagnostic imaging / Q000473:pathology; D009916:Orbital Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D015641:Radiography, Interventional / Q000295:instrumentation / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods