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Magnetic resonance in neuro-oncology: Achievements and challenges
Published in Dževad Belkić, Karen Belkić, Signal Processing in Magnetic Resonance Spectroscopy with Biomedical Applications, 2010
Another way of attaining contrast is via diffusion-weighted imaging (DWI), based upon the molecular motion of water. This technique has been helpful in providing earlier detection of pathology, including brain tumors. Diffusion-weighted imaging can also help distinguish malignancy from secondary effects of treatment on the tumor. However, the findings on DWI are not pathognomonic for neoplasia [209, 217, 218]. The role of MRI versus stereotactic biopsy in brain tumor diagnostics has been described succinctly by Howe and Opstad [207]. They emphasize that accurate diagnosis is vital for optimum clinical management of patients with intra-cranial tumors. Accessible tumors are generally surgically resected, but there is “a balance between removing as much tumor tissue as possible, whilst maintaining vital brain functions” (p.123). Thus, radiation therapy (RT) is frequently also used to treat residual tumor. Magnetic resonance imaging is widely applied to determine tumor extent for surgical and RT planning, as well as for post-therapy monitoring of tumor recurrence or progression to higher grade. The initial diagnosis of an intracranial mass lesion is accurately made in 30–90% of cases, depending on tumor type. However, a biopsy is still considered the gold standard. Furthermore, Howe and Opstad [207] point out that brain biopsy has a 1.7% mortality rate, and note that in a study of 550 patients undergoing stereotactic biopsy: 8% had abscesses or inflammatory processes, 2.2% had other lesions, 3.4% of the biopsies were non-diagnostic, and 8% of the patients had complications. Thus, “a non-invasive and accurate prediction of lesion type would reduce unnecessary surgical biopsy procedures for non-cancerous lesions and for less accessible tumors that would be treated by radio- or chemotherapy rather than surgical resection” (p. 123).
Robotic spine surgery: a review of the present status
Published in Journal of Medical Engineering & Technology, 2020
Kalyan Kumar Varma Kalidindi, Jeevan kumar Sharma, Nirdesh Hiremaglur Jagadeesh, Sulaiman Sath, Harvinder Singh Chhabra
The first surgical application of robotics was in 1985 for a brain biopsy using a modified industrial robot [2]. Da Vinci surgical systems was the first operative surgical robot approved by US-FDA in 2000 and designed to facilitate minimally invasive surgery by a surgeon operating from a console [3]. Spine surgical robots have reached market in the 1990s but with varied acceptance in the surgical community. Initial spine surgical robots were based on stereotaxy and preoperative or intraoperative imaging but lacked the real time navigation. New spine robots allow for real time or user operated navigation along an automated robotic arm trajectory. Spine robotic assisted systems received their first FDA clearance in 2004 (Spine Assist®, Medtronic Inc., Dublin, Ireland) [4]. Subsequent generations of Spine Assist®, Renaissance, Mazor XTM and Mazor XTM Stealth Edition were approved by FDA in 2011, 2017 and 2018, respectively. The two other systems which got FDA clearance are ROSA® (Medtech S.A., Montpellier, France) and Excelsius GPS® (Globus Medical Inc., Audubon, PA) [5]. Currently, only pedicle screw placement is performed through robotics. The role of robotics in planning osteotomies, decompression and dural procedures is still under investigation [5].
Towards optimal control of concentric tube robots in stereotactic neurosurgery
Published in Mathematical and Computer Modelling of Dynamical Systems, 2019
K. Flaßkamp, K. Worthmann, J. Mühlenhoff, C. Greiner-Petter, C. Büskens, J. Oertel, D. Keiner, T. Sattel
Since the 1950s stereotactic neurosurgical procedures have been performed with the help of stereotactic frames that fix the head and enable the surgeon to calculate the ideal entry point on the skull as well as the target point that might be located deep in the brain. The stereotactic technique is commonly used for targeting structures of the brain or pathological lesions of just a few millimetres in length [1, p. 124]. Stereotactic neurosurgery is nowadays a standard method for deep brain stimulation and deep brain biopsy and has several other applications, e.g. oncological radiotherapy or treatment of intracerebral haemorrhage [1, pp. 126–135] [2]. State of the art treatment procedures are still restricted to the use of straight cannulas, although curved cannula could have several potential advantages such as the circumvention of hazardous regions inside the brain [1, p. 114]. Regarding patient safety and accuracy of a stereotactic device for the application of curved instruments, several challenges have to be mastered. First, the insertion of surgical instruments must not result in damage of the vulnerable brain parenchyma. Thus, a curved device that passes the brain over a length of several centimetres should be made of biocompatible components that are thin but stable enough not to be deflected at anatomical borders. Second, different options of trajectory curvatures that can be adjusted during the surgical procedure are mandatory due to anatomical variations within the brain. Especially in case of pathologic changes of the brain structure due to tumourthe, oedema or enlarged ventricles alternative trajectories have to be considered.