title: Fusion imaging for intra-operative ultrasound-based navigation in neurosurgery.
abstract: The major shortcoming of image-guided navigation systems is the use of presurgically acquired image data, which does not account for intra-operative changes such as brain shift, tissue deformation and tissue removal occurring during the surgical procedure. Intra-operative ultrasound (iUS) is becoming widely used in neurosurgery but they lack orientation and panoramic view. In this article, we describe our procedure for US-based real-time neuro-navigation during surgery. We used fusion imaging between preoperative magnetic resonance imaging (MRI) and iUS for brain lesion removal in 67 patients so far. Surgical planning is based on preoperative MRI only. iUS images obtained during surgery are fused with the preoperative MRI. Surgery is performed under intra-operative US control. Relying on US imaging, it is possible to recalibrate navigated MRI imaging, adjusting distortion due to brain shift and tissue resection, continuously updating the two modalities. Ultrasound imaging provides excellent visualization of targets, their margins and surrounding structures. The use of navigated MRI is helpful in better understanding cerebral ultrasound images, providing orientation and panoramic view. Intraoperative US-guided neuro-navigation adjustments are very accurate and helpful in the event of brain shift. The use of this integrated system allows for a true real-time feedback during surgery.
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Prada
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Del Bene
authors.affiliation: Università degli Studi di Milano, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Mattei
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Casali
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy.
authors.forename: Assunta
authors.initials: A
authors.lastname: Filippini
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Legnani
authors.affiliation: Department of Neurosurgery, Johns Hopkins University, Baltimore, USA.
authors.forename: Antonella
authors.initials: A
authors.lastname: Mangraviti
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Saladino
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Perin
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy.
authors.forename: Carla
authors.initials: C
authors.lastname: Richetta
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Vetrano
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Università degli Studi di Milano, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Moiraghi
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Saini
authors.affiliation: Department of Neurosurgery, Fondazione IRCCS "Istituto Neurologico C. Besta", via Celoria 11, 20133 Milan, Italy ; Department of Neurosurgery, Johns Hopkins University, Baltimore, USA.
authors.forename: Francesco
authors.initials: F
authors.lastname: DiMeco
keywords: Brain shift; Brain tumor; Fusion imaging; Intraoperative imaging; Navigation; Ultrasound