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Surgical Imaging


Figure 1: A Frameless Stereotactical Intra-operative Navigation System Display


Figure 2: High-field Pre-operative, Intra-operative, and Post-operative Magnetic Resonance Imaging Scans of Patients Undergoing Awake Craniotomy with Language Mapping


Figure 3: Low-field Intra-operative Magnetic Resonance Imaging Scans of a Patient Undergoing Resection of Glioma Figure 4: Intra-operative Ultrasound of a Cystic Glioma


The blue arrows depict additional areas of tumor that were identified and resected after intra-operative magnetic resonance imaging. Source: Leuthardt et al., 2011.13


The resection cavity is evident in the right frontal region. Image courtesy of Pieter Kubben, MD, Maastricht University Medical Center, AZ Maastricht.


Frameless stereotactic neuronavigation does have limitations, which fall into two categories overall. The first consists of poor co-registration between the scan and the patient, usually from non-optimal fitting of the pre-operative MRI and intra-operatively acquired landmarks. Even


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The ultrasound image is co-registered to a magnetic resonance imaging scan using a frameless stereotactical navigation system.


a few millimeters of shift in the location of the reference markers from positioning the patient can introduce problems in co-registration. Another limitation stems from intra-operative brain shift or edema. While these limitations are of concern, newer methods such as intra-operative


US NEUROLOGY


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