Intraoperative Iso-C C-Arm Navigation in Craniospinal Surgery: The First 60 Cases

OBJECTIVE:The intraoperative Iso-C C-arm (Siremobil Iso-C 3D; Siemens Medical Solutions, Erlangen, Germany) provides a unique ability to acquire and view multi-planar three-dimensional images of intraoperative anatomy. Registration for intraoperative surgical navigation may be automated, thus simplifying the operative workflow. METHODS:Iso-C C-arm intraoperative fluoroscopy acquires 100 images, each of which must be 1.8 degrees in a circumferential fashion about an “isocentric” point in space. The system generates a high-resolution isotropic three-dimensional data set that is available immediately after the 90-second C-arm rotation. The data set is ported to the image-guided workstation, registration is immediate and automated, and the surgeon can navigate with millimetric accuracy. The authors prospectively examined data from the initial 60 patients examined with the Iso-C, among whom were cases of anterior and posterior spinal instrumentation from the occiput to the sacrum. Percutaneous and minimally invasive spinal and cranial procedures were also included. RESULTS:Automated registration for image-guided navigation was attainable for anterior and posterior cases from the cranial base and entire spine. In most cases, intraoperative postprocedural imaging with the Iso-C mitigated the need for postoperative imaging. CONCLUSION:Intraoperative Iso-C three-dimensional scanning allows real-time feedback during cranial base and spinal surgery and during procedures involving instrumentation. In most cases, it obviates the need for postoperative computed tomography. Its usefulness is in its simplicity, and it can be easily adapted to the operating room workflow. When coupled with intraoperative navigation, this new technology facilitates complex neurosurgical procedures by improving the accuracy, safety, and time of surgery.

[1]  C Bolger,et al.  Frameless stereotaxy and anterior cervical surgery. , 1999, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[2]  K Ebmeier,et al.  Intraoperative computerized tomography for improved accuracy of spinal navigation in pedicle screw placement of the thoracic spine. , 2003, Acta neurochirurgica. Supplement.

[3]  G B Jacobs,et al.  Frameless stereotactic guidance for surgery of the upper cervical spine. , 1997, Neurosurgery.

[4]  Charles Kuntz,et al.  Accuracy of Thoracic Vertebral Body Screw Placement Using Standard Fluoroscopy, Fluoroscopic Image Guidance, and Computed Tomographic Image Guidance: A Cadaver Study , 2003, Spine.

[5]  Ekkehard Euler,et al.  Three-dimensional CT with a modified C-arm image intensifier: feasibility. , 2002, Radiology.

[6]  F A Jolesz,et al.  Initial Experience With Intraoperative Magnetic Resonance Imaging in Spine Surgery , 2001, Spine.

[7]  D. Simon,et al.  Virtual Fluoroscopy: Computer-Assisted Fluoroscopic Navigation , 2001, Spine.

[8]  D J Quint,et al.  Stereotactic Navigation for Placement of Pedicle Screws in the Thoracic Spine , 2001, Neurosurgery.

[9]  T. Albert,et al.  Image-guided anterior cervical corpectomy. A feasibility study. , 1999, Spine.

[10]  L. Holly,et al.  Frameless stereotaxy for anterior spinal procedures. , 2001, Journal of neurosurgery.

[11]  Andreas Weidner,et al.  Modification of C1–C2 Transarticular Screw Fixation By Image-Guided Surgery , 2000, Spine.

[12]  K. Foley,et al.  Image-guided spine surgery. , 1996, Neurosurgery clinics of North America.

[13]  Ekkehard Euler,et al.  3D imaging with an isocentric mobile C-arm , 2004, European Radiology.

[14]  M. Austin,et al.  Image-Guided Spine Surgery: A Cadaver Study Comparing Conventional Open Laminoforaminotomy and Two Image-Guided Techniques for Pedicle Screw Placement in Posterolateral Fusion and Nonfusion Models , 2002, Spine.

[15]  S. Ondra,et al.  Use of Internal Fiducial Markers in Frameless Stereotactic Navigational Systems during Spinal Surgery: Technical Note , 2000, Neurosurgery.