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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Quantitative comparison of cranial approaches in the anatomy laboratory: A neuronavigation based research method
Francesco Doglietto, Jimmy Qiu, Mayoorendra Ravichandiran, Ivan Radovanovic, Francesco Belotti, Anne Agur, Gelareh Zadeh, Marco Maria Fontanella, Walter Kucharczyk, Fred Gentili
Francesco Doglietto, Francesco Belotti, Marco Maria Fontanella, Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia 25123, Italy
Jimmy Qiu, Walter Kucharczyk, Division of Neuroradiology, Departments of Medical Imaging and Surgery, University Health Network, Toronto, ON M5G 2N2, Canada
Mayoorendra Ravichandiran, Anne Agur, Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON M5S 1A8, Canada
Ivan Radovanovic, Gelareh Zadeh, Fred Gentili, Division of Neurosurgery, Toronto Western Hospital, Department of Surgery, University Health Network, Toronto, ON M5T 2S8, Canada
Author contributions: Doglietto F performed the majority of experiments and wrote the paper; Qiu J developed the final, novel research method and contributed in most experiments; Ravichandiran M developed the first research methods and contributed to most experiments; Radovanovic I contributed to the research method development and participated in all experiments performed at the University of Toronto; Belotti F provided statistical analysis of the data and contributed to some experiments; Agur A provided anatomical supervision of the study and support for the first research methods; Zadeh G contributed to research method development; Fontanella MM provided supervision for the study in Brescia; Kucharczyk W and Gentili F provided full support and supervision of the study in all its phases.
Supported by Fondazione “Giuseppe Alazio”, via Torquato Tasso, 22, 90144 Palermo, Italy (to Doglietto F).
Institutional review board statement: The anatomical study was reviewed and approved by the University Health Network Institutional Review Board (UHN REB number: 09-0130-T).
Institutional animal care and use committee statement: This study did not involve any animal.
Conflict-of-interest statement: None of the authors has conflicts of interest pertaining to the present paper.
Data sharing statement: ApproachViewer guide 1.0 is available from the corresponding author at francesco.doglietto@unibs.it.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Francesco Doglietto, MD, PhD, Assistant Professor, Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Piazzale Spedali Civili 1, Brescia 25123, Italy. francesco.doglietto@unibs.it
Telephone: +39-30-3995587 Fax: +39-30-3995008
Received: May 8, 2017
Peer-review started: May 17, 2017
First decision: June 16, 2017
Revised: July 2, 2017
Accepted: September 12, 2017
Article in press: September 12, 2017
Published online: December 26, 2017
AIM
To describe the development and validation of a novel neuronavigation-based method, which allows the quantification of the anatomical features that define an approach, as well as real-time visualization of the surgical pyramid.
METHODS
The method was initially developed with commercially-available hardware for coordinate collection (a digitizer and a frameless navigation system) and software for volume rendering; dedicated neuronavigation software (ApproachViewer, part of GTx-UHN) was then developed. The accuracy of measurements and the possibility of volumetric rendering of surgical approaches simulated in a phantom were compared among three different methods and commercially-available radiological software. In the anatomy laboratory, ApproachViewer was applied to the comparative quantitative analysis of multiple neurosurgical approaches and was used by many surgeons who were untrained for the research method.
RESULTS
The accuracy of ApproachViewer is comparable to commercially-available radiological software. In the anatomy laboratory, the method appears versatile. The system can be easily used after brief training. ApproachViewer allows for real-time evaluation and comparison of surgical approaches, as well as post-dissection analyses of collected data. The accuracy of the method depends on the navigation registration: with a 1-2 mm registration error, it is adequate for evaluation and comparison of most neurosurgical approaches.
CONCLUSION
This new research method and software allows semi-automated visualization, quantification, and comparison of neurosurgical approaches in the anatomy laboratory.
Core tip: Herein, the authors describe the development and validation of a novel research method that allows quantification of the essential anatomical features of a neurosurgical approach and real-time rendering of its surgical volume. The measurements of ApproachViewer in a phantom with simulated approaches were noted to be largely homogeneous and comparable with those of other research methods. The authors further demonstrated the actual application of ApproachViewer in anatomical dissections to elaborate the advantages of real time 3D rendering and quantification. ApproachViewer provides a good alternative solution for fast 3D rendering and post-dissection analyses in a preclinical setting.
