Intraoperative computed tomography for complex craniocervical operations and spinal tumor resections

OBJECTIVE: To improve intraoperative observation of unexposed anatomic feat ures and to verify surgical correction, a mobile computed tomographic (CT) scanner has been introduced into the operating room. To date, intraoperativ e CT scanning has been used predominantly for intracranial procedures. We r eport on the expanded use of intraoperative CT scanning for spinal surgery, because CT scanning provides excellent observation of osseous pathological features. We report on our first 17 cases, which involved complex cranioce rvical operations and spinal tumor resections. METHODS: The Tomoscan M CT scanner (Philips Medical Systems, Eindhoven, The Netherlands) is mobile and consists of a translatable gentry, a translatab le table, and an operator's workstation. In the operating room, the patient is placed on the CT table and prepared in the usual manner. The aperture o f the gentry is covered with sterile plastic drapes. The gantry is docked t o the table for intraoperative CT scanning as needed for navigation and ver ification during surgery. Each series of scans requires approximately 15 to 20 minutes. RESULTS: Our initial experience with neurosurgical spinal cases demonstrate d that the use of intraoperative CT scanning changed the course of surgery in 6 of 17 cases. CT scanning was beneficial in facilitating adequate ventr al clival and craniocervical decompressions, promoting more complete tumor resections, and verifying correct graft and instrument placement before sur gical closing. Other settings in which we have found the mobile CT scanner useful include the neurointerventional suite and the intensive cave unit; i t is also useful for radiotherapy planning. CONCLUSION: On the basis of findings for our first 17 spinal surgery cases, we conclude that intraoperative CT scanning of the spine is both feasible and beneficial for select complex spinal procedures from the craniocervical junction to the sacrum.