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Background. Lateral approaches to the spine have gained increased popularity due to enabling minimally invasive access to the spine, less blood loss, decreased operative time, and less postoperative pain. The objective of the study was to analyze the use of intraoperative computed tomography with navigation and the implementation of augmented reality in facilitating a lateral approach to the spine. Methods. We prospectively analyzed all patients who underwent surgery with a lateral approach to the spine from September 2016 to January 2021 using intraoperative CT applying a 32-slice movable CT scanner, which was used for automatic navigation registration. Sixteen patients, with a median age of 64.3 years, were operated on using a lateral approach to the thoracic and lumbar spine and using intraoperative CT with navigation. Indications included a herniated disc (six patients), tumors (seven), instability following the fracture of the thoracic or lumbar vertebra (two), and spondylodiscitis (one). Results. Automatic registration, applying intraoperative CT, resulted in high accuracy (target registration error: 0.84 ± 0.10 mm). The effective radiation dose of the registration CT scans was 6.16 ± 3.91 mSv. In seven patients, a control iCT scan was performed for resection and implant control, with an ED of 4.51 ± 2.48 mSv. Augmented reality (AR) was used to support surgery in 11 cases, by visualizing the tumor outline, pedicle screws, herniated discs, and surrounding structures. Of the 16 patients, corpectomy was performed in six patients with the implantation of an expandable cage, and one patient underwent discectomy using the XLIF technique. One patient experienced perioperative complications. One patient died in the early postoperative course due to severe cardiorespiratory failure. Ten patients had improved and five had unchanged neurological status at the 3-month follow up. Conclusions. Intraoperative computed tomography with navigation facilitates the application of lateral approaches to the spine for a variety of indications, including fusion procedures, tumor resection, and herniated disc surgery.

We present the integration of the OpenIGTLink network protocol for image-guided therapy (IGT) with the medical prototyping platform MeVisLab. OpenIGTLink is a new, open, simple and extensible network communication protocol for IGT. The protocol provides a standardized mechanism to connect hardware and software by the transfer of coordinate transforms, images, and status messages. MeVisLab is a framework for the development of image processing algorithms and visualization and interaction methods, with a focus on medical imaging. The integration of OpenIGTLink into MeVisLab has been realized by developing a software module using the C++ programming language. As a result, researchers using MeVisLab can interface their software to hardware devices that already support the OpenIGTLink protocol, such as the NDI Aurora magnetic tracking system. In addition, the OpenIGTLink module can also be used to communicate directly with Slicer, a free, open source software package for visualization and image analysis. The integration has been tested with tracker clients available online and a real tracking system., Comment: 18 pages, 5 figures, 1 table, 30 references

Diffusion Tensor Imaging (DTI) is a non-invasive imaging technique that allows estimation of the location of white matter tracts in-vivo, based on the measurement of water diffusion properties. For each voxel, a second-order tensor can be calculated by using diffusion-weighted sequences (DWI) that are sensitive to the random motion of water molecules. Given at least 6 diffusion-weighted images with different gradients and one unweighted image, the coefficients of the symmetric diffusion tensor matrix can be calculated. Deriving the eigensystem of the tensor, the eigenvectors and eigenvalues can be calculated to describe the three main directions of diffusion and its magnitude. Using DTI data, fiber bundles can be determined, to gain information about eloquent brain structures. Especially in neurosurgery, information about location and dimension of eloquent structures like the corticospinal tract or the visual pathways is of major interest. Therefore, the fiber bundle boundary has to be determined. In this paper, a novel ray-based approach for boundary estimation of tubular structures is presented., Comment: 5 pages, 2 figures, 7 references

Diffusion Tensor Imaging (DTI) allows estimating the position, orientation and dimension of bundles of nerve pathways. This non-invasive imaging technique takes advantage of the diffusion of water molecules and determines the diffusion coefficients for every voxel of the data set. The identification of the diffusion coefficients and the derivation of information about fiber bundles is of major interest for planning and performing neurosurgical interventions. To minimize the risk of neural deficits during brain surgery as tumor resection (e.g. glioma), the segmentation and integration of the results in the operating room is of prime importance. In this contribution, a robust and efficient graph-based approach for segmentating tubular fiber bundles in the human brain is presented. To define a cost function, the fractional anisotropy (FA) is used, derived from the DTI data, but this value may differ from patient to patient. Besides manually definining seed regions describing the structure of interest, additionally a manual definition of the cost function by the user is necessary. To improve the approach the contribution introduces a solution for automatically determining the cost function by using different 3D masks for each individual data set., Comment: 4 pages, 3 figures, BMT 2010, Rostock

The glioblastoma multiforme is the most common malignant primary brain tumor and is one of the highest malignant human neoplasms. During the course of disease, the evaluation of tumor volume is an essential part of the clinical follow-up. However, manual segmentation for acquisition of tumor volume is a time-consuming process. In this paper, a new approach for the automatic segmentation and volume determination of glioblastomas (glioblastoma multiforme) is presented and evaluated. The approach uses a user-defined seed point inside the glioma to set up a directed 3D graph. The nodes of the graph are obtained by sampling along rays that are sent through the surface points of a polyhedron. After the graph has been constructed, the minimal s-t cut is calculated to separate the glioblastoma from the background. For evaluation, 12 Magnetic Resonance Imaging (MRI) data sets were manually segmented slice by slice, by neurosurgeons with several years of experience in the resection of gliomas. Afterwards, the manual segmentations were compared with the results of the presented approach via the Dice Similarity Coefficient (DSC). For a better assessment of the DSC results, the manual segmentations of the experts were also compared with each other and evaluated via the DSC. In addition, the 12 data sets were segmented once again by one of the neurosurgeons after a period of two weeks, to also measure the intra-physician deviation of the DSC., Comment: 4 pages, 4 figures, BMT 2010, Rostock

The most common primary brain tumors are gliomas, evolving from the cerebral supportive cells. For clinical follow-up, the evaluation of the preoperative tumor volume is essential. Volumetric assessment of tumor volume with manual segmentation of its outlines is a time-consuming process that can be overcome with the help of computerized segmentation methods. In this contribution, two methods for World Health Organization (WHO) grade IV glioma segmentation in the human brain are compared using magnetic resonance imaging (MRI) patient data from the clinical routine. One method uses balloon inflation forces, and relies on detection of high intensity tumor boundaries that are coupled with the use of contrast agent gadolinium. The other method sets up a directed and weighted graph and performs a min-cut for optimal segmentation results. The ground truth of the tumor boundaries - for evaluating the methods on 27 cases - is manually extracted by neurosurgeons with several years of experience in the resection of gliomas. A comparison is performed using the Dice Similarity Coefficient (DSC), a measure for the spatial overlap of different segmentation results., Comment: 4 pages, 5 figures, Proc. of the 6th Russian-Bavarian Conference on Bio-Medical Engineering

Diffusion Tensor Imaging (DTI) provides the possibility of estimating the location and course of eloquent structures in the human brain. Knowledge about this is of high importance for preoperative planning of neurosurgical interventions and for intraoperative guidance by neuronavigation in order to minimize postoperative neurological deficits. Therefore, the segmentation of these structures as closed, three-dimensional object is necessary. In this contribution, two methods for fiber bundle segmentation between two defined regions are compared using software phantoms (abstract model and anatomical phantom modeling the right corticospinal tract). One method uses evaluation points from sampled rays as candidates for boundary points, the other method sets up a directed and weighted (depending on a scalar measure) graph and performs a min-cut for optimal segmentation results. Comparison is done by using the Dice Similarity Coefficient (DSC), a measure for spatial overlap of different segmentation results., Comment: 4 pages, 6 figures, BIOSIGNAL, Berlin, 2010

We present a novel method that allows for measuring the quality of diffusion-weighted MR images dependent on the image resolution and the image noise. For this purpose, we introduce a new thresholding technique so that noise and the signal can automatically be estimated from a single data set. Thus, no user interaction as well as no double acquisition technique, which requires a time-consuming proper geometrical registration, is needed. As a coarser image resolution or slice thickness leads to a higher signal-to-noise ratio (SNR), our benchmark determines a resolution-independent quality measure so that images with different resolutions can be adequately compared. To evaluate our method, a set of diffusion-weighted images from different vendors is used. It is shown that the quality can efficiently be determined and that the automatically computed SNR is comparable to the SNR which is measured manually in a manually selected region of interest.