MRI-guided Navigation Surgery with Temporary Implantable Bone Markers in Limb Salvage for Sarcoma

Abstract

Background Technical errors during navigation-assisted bone tumor resection may occur by: (1) incorrect registration of images and corresponding anatomic points of bone sent to the navigation system; and (2) incorrect fusion of two or more images that have been transported to the navigation system. Questions/purposes We investigated new methods of navigation surgery to minimize technical errors during the registration and image fusion processes and specifically asked whether a navigated cannula probe would reduce unnecessary soft tissue dissection, and allow percutaneous registration and implantation of a reference base tracker in the margin of bone to be resected. Methods We performed direct MRI-guided navigation surgery without image fusion on a patient with osteosarcoma using absorbable pins as temporary implanted bone markers that prevent artifacts on MR images. Results Direct MRI-guided navigation surgery was possible using bone markers. A navigated cannula probe allowed percutaneous registration and a navigated blade-shaped probe provided a real-time check on the narrow osteotomy gap. The surgical procedure was facilitated by implantation of a reference base tracker on the margin of bone to be resected. Conclusions Our modified technique of MRI-guided navigation surgery for patients with a malignant bone tumor may reduce processing errors by increased accuracy and be helpful for joint preserving surgery.