Claudio Munari Center For Epilepsy And Parkinson Surgery Ao Ospedale Niguarda Ca Granda

Milano, Italy

Claudio Munari Center For Epilepsy And Parkinson Surgery Ao Ospedale Niguarda Ca Granda

Milano, Italy
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De Momi E.,Polytechnic of Milan | Caborni C.,Polytechnic of Milan | Cardinale F.,Claudio Munari Center For Epilepsy And Parkinson Surgery Ao Ospedale Niguarda Ca Granda | Castana L.,Claudio Munari Center For Epilepsy And Parkinson Surgery Ao Ospedale Niguarda Ca Granda | And 4 more authors.
IEEE Transactions on Biomedical Engineering | Year: 2013

In StereoElectroEncephaloGraphy (SEEG) procedures, intracerebral electrodes are implanted in order to identify the epileptogenic zone in drug-resistant epileptic patients. This paper presents an automatic multitrajectory planner that computes the best trajectory in terms of distance from vessels and guiding screws angle, once the candidate entry and target regions are quickly and roughly defined. The planning process is designed also to spare some brain structures, such as cella media and trigone of the lateral ventricles and brain stem. The planner was retrospectively evaluated on 15 patients who had previously undergone SEEG investigation. Quantitative comparison was performed computing for each patient and for each electrode trajectory 1) the Euclidean distance from the closest vessel; 2) the trajectory incidence angle (guiding screws angle); and 3) the sulcality value. The automatic planner proved to satisfy the clinical requirements, planning safe trajectories in a clinical-compatible timeframe. Qualitative evaluation performed by three neurosurgeons showed that the automatically computed trajectories would have been accepted by them. © 2012 IEEE.


PubMed | Claudio Munari Center For Epilepsy And Parkinson Surgery Ao Ospedale Niguarda Ca Granda and Polytechnic of Milan
Type: Journal Article | Journal: International journal of computer assisted radiology and surgery | Year: 2016

Image guidance is widely used in neurosurgery. Tracking systems (neuronavigators) allow registering the preoperative image space to the surgical space. The localization accuracy is influenced by technical and clinical factors, such as brain shift. This paper aims at providing quantitative measure of the time-varying brain shift during open epilepsy surgery, and at measuring the pattern of brain deformation with respect to three potentially meaningful parameters: craniotomy area, craniotomy orientation and gravity vector direction in the images reference frame.We integrated an image-guided surgery system with 3D Slicer, an open-source package freely available in the Internet. We identified the preoperative position of several cortical features in the image space of 12 patients, inspecting both the multiplanar and the 3D reconstructions. We subsequently repeatedly tracked their position in the surgical space. Therefore, we measured the cortical shift, following its time-related changes and estimating its correlation with gravity and craniotomy normal directions.The mean of the median brain shift amount is 9.64 mm ([Formula: see text] mm). The brain shift amount resulted not correlated with respect to the gravity direction, the craniotomy normal, the angle between the gravity and the craniotomy normal and the craniotomy area.Our method, which relies on cortex surface 3D measurements, gave results, which are consistent with literature. Our measurements are useful for the neurosurgeon, since they provide a continuous monitoring of the intra-operative sinking or bulking of the brain, giving an estimate of the preoperative images validity versus time.

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