Intraoperative Computed

Tomography in Cranial
Neurosurgery
Christian Schichor, MD*, Nicole Terpolilli, MD,
Jun Thorsteinsdottir, MD, Jrg-Christian Tonn, MD

Jhon Fernando Cern Narvez

 INTRODUCTION
Modalities for intraoperative imaging
1980s
1990s
Newest generations of iCT scanners
 METHODS AND TECHNOLOGY
January 1, 2006, to August 31, 2014.
SIEMENS HEALTHCARE SOMATOM
2850Kg
20-128 CORTES
Sistema de enfriamiento 100kW
Sistema de disipado de 1300kW
 RESULTS

Work Flow
safety check
Position
3-D CT-angio
iCT-perfusion
 Radiation Exposure
highest radiation (CT angiography)
3.69 mSv.
Skullbase Neurosurgery
orbit, paraorbital structures and the optic nerve,
Resection, optimizing both functional results and
tumor control (iCT)
 Neuronavigation
 Control of resection
extensive tumors
functional outcome in this series was good or
excellent in 82.6%
irradiation of the remaining tumor was added
(2/19 cases).
 Vascular Neurosurgery
Intraoperative
CT-angiography
(iCTA)
iCT in
neurovascular
microsurgery
good or excellent
in all cases
 Adverse Events
we did not encounter complications related to
the scanning procedure itself
We did not find any minor or major adverse
events related to contrast agent injection
 DISCUSSION
first intraoperative computed tomography for
neurosurgery was reported by Shalit and
colleagues in 1979
intraoperative magnetic resonance imaging
technology is the best possible technique in order
to determine the extent of resection in patients
harboring intra-axial malignant tumors or low-
grade gliomas
 intraoperative MRI techniques are mostly
restricted to cranial procedures whereas
intraoperative CT imaging could also be used by
spine surgeons as well as trauma surgeons
the use of neuro-navigational systems (NNS) was
recommended earlier in order to provide the
responsible neurosurgeon valuable information