Application of Multimodal Image Fusion to Precisely Localize Small Intramedullary Spinal Cord Tumors.

Objective We sought to study the application of precise intraoperative localization of small intramedullary spinal cord tumors. Methods From November 2015 to August 2017, 5 patients with small intramedullary spinal cord tumors were arranged in this group. By using the O-arm image system, we acquired the intraoperative computed tomography images of all patients and sent them to the Stealth navigation system. Medtronic Synergy Cranial software was used to complete the image fusion with preoperative magnetic resonance images, and the fused images were used to localize the intramedullary spinal cord tumors by the navigation system. The navigation errors were evaluated by measuring the maximum distance between the end of the tumor in sagittal magnetic resonance imaging and its real position. Results Five patients accomplished the multimodal image fusion, and we successfully completed the image-guided surgeries. The mean diameter of tumors was 12.2 ± 3.1 mm in sagittal magnetic resonance imaging, and the mean incision length was 12.7 ± 3.3 mm. The time of image processing was between 13 minutes and 17 minutes, and the mean value was 15 ± 1.6 minutes. The navigation error was between 0.9 mm and 1.5 mm, and the mean value was 1.2 ± 0.2 mm. Conclusions The application of the multimodal image fusion combined with intraoperative O-arm image navigation system can be used to localize small intramedullary tumors. Highlights • By using the O-arm and Stealth navigation system, we completed the image fusion with preoperative MRI. • The fused images were used to localize the intramedullary spinal cord tumors aided by the navigation system. • Application of the multimodal image fusion combined with intraoperative O-arm image navigation system was completed. • Our results confirmed this technique's clinical feasibility and value. [ABSTRACT FROM AUTHOR]