Stereotactic operations using the o-arm.
BACKGROUND
In stereotactic operations, intraoperative imaging is crucial in several stages of the procedure. The aim was to utilize the O-arm intraoperatively for (1) planning the trajectories of stereotactic instruments, (2) calculating the coordinates of the targets, (3) identification of normal intracranial structures, (4) verification of the trajectories of the stereotactic instruments, and (5) visualization of intracranial hematoma. This is the first study using the O-arm for calculations of the target coordinates in frame-based stereotaxy.


METHODS
Utilization of the O-arm as a full-scale intraoperative imaging system in stereotactic surgery required a new concept. The concept consists of the O-arm as an intraoperative imaging system and the Leksell stereotactic system with a modified CT coordinate indicator box, with the idea to widen limited imaging volume. The accuracy and feasibility of the concept were studied.


RESULTS
The use of O-arm imaging was found to be clinically feasible, enabling the achievement of adequate technical accuracy for stereotactic operations with submillimeter errors in the calculation of target coordinates, and for multiple intraoperative control images when required.


CONCLUSIONS
The O-arm could be used alone, with high accuracy, as an intraoperative imaging system for planning and controlling in stereotactic operations. In addition, it can be used to exclude serious complications, especially intracerebral hematoma.
Department of Neurosurgery, Oulu University Hospital, Oulu, Finland. jani.katisko@oulu.fi
Jani Petri Antton
JP
Katisko
Mikko Tapio
MT
Kauppinen
John Pertti
JP
Koivukangas
Esa Raimo
ER
Heikkinen
D016477:Artifacts; D001863:Bone Screws; D001864:Bone Wires; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000517:prevention & control*; D003399:Craniotomy / Q000379:methods; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods / Q000592:standards; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods / Q000592:standards; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control*; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D010300:Parkinson Disease / Q000601:surgery* / Q000628:therapy; D012984:Software; D013238:Stereotaxic Techniques / Q000009:adverse effects / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods / Q000592:standards