title: Use of a Mobile Intraoperative Computed Tomography Scanner for Navigation Registration During Laser Interstitial Thermal Therapy of Brain Tumors.
abstract: OBJECTIVE
  In recent years laser interstitial thermal therapy (LITT) has become the ablative neurosurgical procedure of choice. Multiple methods for registration and laser fiber verification have been described, with each method requiring multiple steps and significant time expenditure. We evaluated the use of a commercially available mobile computed tomography (CT) scanner for stereotactic registration during LITT for brain tumors in an attempt to simplify the procedure and improve intraoperative awareness of laser position.
  
  
  METHODS
  This is a retrospective chart review comparing LITT of brain tumors in 23 patients undergoing a standard protocol requiring skull pins and transport of the patient to a CT suite to obtain a reference scan compared with 14 patients in whom the Medtronic O-arm was used intraoperatively for navigation registration and confirmation of laser position.
  
  
  RESULTS
  Total ablation of the target was achieved in all patients with no surgical complications. Total surgery time was shorter for the O-arm group than for the standard protocol group, once experience was gained with bringing the O-arm in and out of the surgical field. Return from the magnetic resonance imaging suite to the operating room for repositioning of the laser was required for 1 patient in the standard protocol group, but for no patients in the O-arm group. Once experience was gained with using the O-arm, estimated surgical costs were lower for this group.
  
  
  CONCLUSIONS
  Use of a mobile intraoperative CT scanner for navigation registration and confirmation of laser position during LITT may play a role in streamlining the procedure and improving patient safety and comfort.
authors.affiliation: Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA. Electronic address: walter.jermakowicz@jhsmiami.org.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Jermakowicz
authors.affiliation: Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Diaz
authors.affiliation: Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Cass
authors.affiliation: Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Ivan
authors.affiliation: Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000295:instrumentation*; D053685:Laser Therapy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000295:instrumentation*; D012189:Retrospective Studies; D013382:Subtraction Technique / Q000295:instrumentation; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*; D016896:Treatment Outcome
keywords: Brain tumor surgery; Cost; Intraoperative imaging; Neuronavigation; Thermal ablation