Intraoperative AIRO mobile computer tomography in frameless stereotactic procedures

Abstract

Background

Multiple factors can affect the accuracy of neuronavigation, that is a relevant issue, particularly for frameless stereotactic procedures, where precision and optimal image-guidance is crucial for the surgical performance, workflow, and outcome.

Objective

To investigate the impact of AIRO Mobile Computer Tomography in frameless stereotactic approaches.

Methods

A retrospective study on 12 patients was performed. All the procedures were deployed using a frameless stereotactic technique, both for the collection of biopsy pathological specimens for diagnosis and insertion of drainage in the treatment of intracranial cystic lesions.

Results

Twelve patients (eight males, four females) underwent the frameless stereotactic procedure. Mean age at surgery was 55 (±5 SE). The mean volume of the lesion was 23.85 cm³ (±3.13). Six diagnostic biopsies and six cyst drainages were performed. The mean trajectory length was 75.9 ± 11.8 mm. Three posterior fossa lesions (27%) were approached through a retro-sigmoidal burr-hole. A craniotomy for draining a haematoma was performed after detection with AIRO-CT. No permanent neurological dysfunction, in-hospital or 30-day mortality were recorded.

Conclusion

The AIRO-CT resulted feasible with a potential utility for stereotactic procedures. We showed how it could grant the efficacy of the stereotactic procedures reducing some technical and physical sources of inaccuracy, also enhancing safety and allowing prompt detection and management of intraoperative complications.

Keywords:

• Computed tomography
• intraoperative imaging
• neuronavigation
• frameless stereotaxis

Ethical approval

All procedures were performed in accordance with the ethical standards of the institutional committee (Humanitas Research Hospital, authorization no. 1661/2016) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Acknowledgments

The authors thank Stefania Radice, M.D., for the clinical management of the patients. The authors show our gratitude to the staff of the operating room, in particular to Mauro Ziano, Antonietta De Rinaldis, Sarah Besozzi, Matteo Magistrelli, Fabrizio Calì, Vallejo Arantxa, Giovanni Longo and Michele Laccone for their efforts in setting up the intraoperative hardware and in aiding during the acquisitions.

Informed consent

Informed consent for surgery was obtained from all participants included in the study.

Disclosure statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript, but M.Riva (Brainlab A.G., scientific consultant).

No funding was received for this research.

Previous presentation

No preliminary results of the current study were presented.

ORCIDs details

Marco Riva, 0000-0003-4643-6451