Survey PaperBrain shift in neuronavigation of brain tumors: A review
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Section snippets
Introduction
Since the introduction of the first intraoperative frameless stereotactic navigation device by Roberts et al. (1986), image guided neurosurgery (IGNS), or ``neuronavigation'' has become an essential tool for many neurosurgical procedures due to its ability to minimize surgical trauma by enabling precise localization of surgical targets. Over the past 30 years, the growth of this technology has enabled application to increasingly complicated interventions including the surgical treatment of
Search methodology
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines without prior publication of the review protocol (Moher et al., 2009). PubMed2 was used to search several specific keywords and phrases:
(brain or tissue) and (shift or deformation) or (modeling or predicti* or registration) or (measure* or quantif*) or (intraoperative or imag*) or (9euronavigation accuracy)
All returned titles were screened and
Causes of brain shift
The first article to report on the phenomenon of brain shift was published in 1986 by Kelly et al. (1986), just prior to the release of the first frameless stereotaxic system developed by Roberts et al. (1986). Kelly et al. (1986) observed a dislocation of small steel balls placed along the line of view of the surgeon during volumetric stereotaxy. While they documented observing the shift, at that time there was no equipment available to perform any extensive quantitative measurements of the
Measurement of brain shift
As the use of 15euronavigation became more prevalent and widespread in neurosurgical interventions, the need for measuring the origins of inaccuracies caused by brain shift also became important. With the effects of brain shift making 15euronavigation systems unreliable for a large part of surgery, many investigators developed techniques to measure the subsequent shifts while attempting to attribute their cause. In order to assess the magnitude of brain shift there have been two main
Compensation of brain shift
When discussing methods for compensating for the effects of brain shift in neuronavigation we find two main streams in the literature; methods that focus on the registration of intraoperative images and methods where intraoperative information is sparse or absent and thus the focus on modeling the shift through biomechanical or predictive models. In many of the different methods a combination of approaches are used and each has different benefits and drawbacks. Registration methods obviously
Discussion
It is evident from the work described above that brain shift is a very complex problem that has widespread causes ranging from the limitations of the technical components of the neuronavigation hardware, surgical causes from equipment resection of tissue and loss of fluid, as well as biological effects related to drug administration and the type of brain tumor present. The work done to describe the contributions from these different factors has led to numerous strategies to quantify the
Conclusion
We presented a review of the research evaluating the causes, measurements and correction methods of brain shift in neuronavigation with a newly proposed taxonomy for classifying the different types of studies. With the increasingly ubiquitous use of neuronavigation systems in neurosurgical interventions, the need for highly accurate information has become of utmost importance. Brain shift is a well-documented phenomenon and one of the largest contributors to inaccurate neuronavigation. While
Disclosure of funding
This work was funded in part by NSERC (238739) and CIHR (MOP-97820) and an NSERC CHRP (385864-10) and a Brain Canada Student Fellowship.
Conflict of interest
All authors declare they have no conflict of interest.
Acknowledgments
We acknowledge funding support from Canadian Institutes of Health Research (MOP-84360 and MOP-111169), the Canadian National Science and Engineering Research Council (238739), and Brain Canada.
Ian J. Gerard, M.Sc. is a Ph.D. candidate in biomedical engineering at McGill University. His current research involves improving the accuracy of neuronavigation tools for image-guided neurosurgery of brain tumors with focus on intraoperative imaging for brain shift management and enhanced visualization techniques for understanding complex medical imaging data.
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Ian J. Gerard, M.Sc. is a Ph.D. candidate in biomedical engineering at McGill University. His current research involves improving the accuracy of neuronavigation tools for image-guided neurosurgery of brain tumors with focus on intraoperative imaging for brain shift management and enhanced visualization techniques for understanding complex medical imaging data.
Marta Kersten-Oertel, Ph.D. is a postdoctoral fellow at the Montreal Neurological Institute, specializing in medical image visualization and image-guided neurosurgery. Her current research involves the development of an augmented reality neuronavigation system and the combination of advanced visualization techniques with psychophysics in order to improve the understanding of complex medical imaging data.
Kevin Petrecca, M.D. Ph.D. is a neurosurgeon, assistant professor of neurology and neurosurgery at McGill University, and head of neurosurgery at the Montreal Neurological Hospital, specializing in neurosurgical oncology. His research at the Montreal Neurological Institute and Hospital Brain Tumor Research Center focuses on understanding fundamental molecular mechanisms that regulate cell motility with a focus on malignant glial cell invasion. His clinical research program focuses on developing intraoperative tools to improve brain cancer surgery including MRI-coregistered ultrasound and spectroscopy-guided surgery.
Denis Sirhan, M.D. is a neurosurgeon at the Montreal Neurological Institute and Hospital who specializes in skullbase approaches for complex tumors. He has wide experience in microvascular decompressions for different pathologies. His current research, in collaboration with other MNI clinician-scientists, involves the development of augmented reality visualizations in neuronavigation systems during image-guided tumor and vascular surgeries.
Jeffery A. Hall, M.D. M.Sc. is a neurosurgeon and assistant professor of neurology and neurosurgery at McGill University's Montreal Neurological Institute and Hospital, specializing in the surgical treatment of epilepsy and cancer. His current research, in collaboration with other MNI clinician-scientists includes: developing non-invasive means of delineating epileptic foci, intraoperative imaging in combination with neuronavigation systems and the application of image-guided neuronavigation to epilepsy surgery.
D. Louis Collins, Ph.D. is a professor in neurology and neurosurgery, biomedical engineering and associate member of the Center for Intelligent Machines at McGill University. His laboratory develops and uses computerized image processing techniques such as non-linear image registration and model-based segmentation to automatically identify structures within the brain. His other research focuses on applying these techniques to image guided neurosurgery to provide surgeons with computerized tools to assist in interpreting anatomical, functional, and vascular imaging data permitting effective planning and execution of minimally invasive neurosurgical procedures.