Mapping the Progression of Resection Continuously during Brain Tumor Surgery

摘要

Objective: This purpose of this study was to develop and validate methods for monitoring the progression of resection during the neurosurgical removal of brain tumors. Methods: An optical tracking array was attached to a surgical instrument to track its tip position relative to preoperative imaging. The tip position was monitored continuously during surgery and used to generate a map of resection progression in the form of a 3D distance field. This method was validated on 18 brain phantoms by comparing resection maps to 3D ultrasound acquired before and after resection. A clinically compatible workflow was iteratively developed and optimized during more than 15 clinical cases with input and feedback from two neurosurgeons. Results: Phantom studies showed that resection maps accurately model the actual resection cavity, with an average of 97.5% of voxels inside the actual resection cavity lying within 2 mm of the resection map and an average of 94.7% of tracked resection points lying within 2 mm of the actual resection cavity. In clinical workflow studies, a variety of surgical instruments were tracked continuously with minimal disruption to surgery. Preliminary clinical data demonstrated that the resection map can be used to flag brain shift and predict residual tumor. Conclusion: Continuous monitoring of the progression of brain tumor resection can be done accurately and with minimal disruption in the operating room. Significance: Providing a real-time map of resection progression will reduce the cognitive load on neurosurgeons and facilitate more complete resections, particularly during long, complex surgeries.