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Role of navigation in CSF rhinorrhea
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Hemanth Vamanshankar, Jyotirmay S. Hegde
The future of neuronavigation seems promising. The development of i-CT technology has provided better image quality with no radiation burden, as compared to previous intraoperative CT. Production of MR imaging compatible instruments, and combining i-CR and i-MR imaging, would bring about better imaging quality intra-op. Imaging with SPECT and PET, which is presently not possible in the operating room due to radiation hazards and cost concerns, would open a door of new possibilities.31 Another exciting field is microscanning, i.e., ultrasonographic scanning at higher frequencies, which can bring about imaging histological specimens in 3-D without the need for staining/sectioning. Wells et al. also describe this technique in gene transfection by delivering high-intensity localized ultrasound to individually targeted cells.32 Finally, the advent of robotics combined with navigation may enable performing skull base procedures at distant locations with the use of telerobotic technology.
Neurosurgery: Neuroendocrine lesions
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
The decision to operate on these patients should be based on the risk and benefit between surgical management and the patient's associated comorbidities. In addition, decreased physiological reserve predisposing this population to increased surgical and anesthesia-related complications, must be considered (15–17). Pituitary tumors can be approached either by craniotomy or transsphenoidal (endoscopic or microscopic) routes. The endonasal approach has several advantages over the microscopic approach, including panoramic view of the surgical site and fewer complications. The current use of intraoperative neuronavigation and imaging studies has drastically enhanced the safety and improved the outcome during surgery.
Visual Perception and Human–Computer Interaction in Surgical Augmented and Virtual Reality Environments
Published in Terry M. Peters, Cristian A. Linte, Ziv Yaniv, Jacqueline Williams, Mixed and Augmented Reality in Medicine, 2018
Roy Eagleson, Sandrine de Ribaupierre
Over the last two decades, an increasing number of research and commercial systems have surfaced for neurosurgical applications. While VR can mainly be used for training only, AR can be used from training to planning and/or navigating in the operating room. We concentrate here on the visual perception and human–computer interaction aspects of computer graphics for augmenting the display, without an extensive review of either modality in neurosurgery. The first successful commercial system was the addition of AR to the microscope. It was first described in Edwards et al. (1996), and the first commercial microscope was described in Haase (1999). The advantage of the microscope is that the focal point where the surgeon is looking and working is known and therefore can be accurately followed in depth, in addition to the (x, y) coordinates that are known by tracking the microscope with neuronavigation. The image can then be either reflected in the lenses and seen when looking through the microscope in the surgical scene or drawn on top of the camera’s image from the microscope on the screen. This has been implemented by most of the surgical microscope companies collaborating with the neuronavigation systems. The usability and impact of such systems have mostly been studied through case series, with a few papers examining the clinical impact of the AR display. For example, in the case of vascular surgery, a team has determined that in clipping cerebral aneurysms, AR may have impacted 16.7% of the surgeries in facilitating the positioning of the clip (Cabrilo et al., 2014).
Computer-assisted surgery in medical and dental applications
Published in Expert Review of Medical Devices, 2021
Yen-Wei Chen, Brian W. Hanak, Tzu-Chian Yang, Taylor A. Wilson, Jenovie M. Hsia, Hollie E. Walsh, Huai-Che Shih, Kanako J. Nagatomo
Understanding the spatial relationship of relevant pathologies to the surrounding vital brain structures has always been critical to the performance of safe and reproducible neurosurgical procedures. Neuronavigation arose as an attempt to more precisely localize anatomical structures throughout an individual patient’s brain by using the patient’s own preoperative imaging as the reference rather than normalized cadaveric data. Neuronavigation systems have now become ubiquitous in the modern practice of neurosurgery, allowing the registration of the patient’s head with their preoperative cross-sectional imaging studies (including CT and MRI). Thus, anatomic structures and pathologic findings visible on imaging, though not always obvious grossly, can be precisely localized throughout surgery. Neuronavigation allows the merging of multiple preoperative neuroimaging studies to produce three-dimensional renderings and facilitate the design of trajectories to anatomic or pathologic targets of interest. Currently, the most widely used neuronavigation systems in the United States are manufactured by Brainlab (Curve®, Kick®, Kick® EM), Medtronic (StealthStation™ S8), and Stryker (NAV3i Platform™, CranialMap™ 3.0 Navigation Software).
Endoscopic approach for a delayed post-traumatic ethmoidal mucocele: a technical note
Published in British Journal of Neurosurgery, 2019
Mahmoud Messerer, Giulia Cossu, Roy Thomas Daniel
A post-traumatic mucocele may develop years after the head trauma.The treatment is surgical and a wide opening of the paranasal sinus is mandatory.The extension of the mucocele and areas of bone erosion should be evaluated preoperatively.A preoperative analysis of the trajectory of the ON and ICA is crucial.An approach contralateral to the lesion may allow a better visualization of lateral structures.The use of a 30° angled-endoscope improves the lateral field of vision.A binostril EEA should be performed with an unfavorable skull base anatomy.With an intra-orbital extension of the mucocele, the ON should be precociously identified and respected.The neuronavigation may be an additional tool to safely perform the procedure.The EEA has a steep learning curve and the patient should be aware of the risk of postoperative complications.
Cerebral gliomas: Treatment, prognosis and palliative alternatives
Published in Progress in Palliative Care, 2018
Dharam Persaud-Sharma, Joseph Burns, Marien Govea, Sanaz Kashan
Surgical resection of gliomas has various advantages. Not only can an accurate diagnosis be made by direct biopsy of the tumor, but it also facilitates the use of adjuvant treatment options to prevent recurrence and prolong survival. Surgery usually begins with a craniotomy to access the brain. Patients are anaesthetized, intubated, and markers are placed before the head is shaved. Modern neurosurgical procedures are now implementing intraoperative imaging to more accurately resect tumors. Neuronavigation uses CT and/or MRI throughout surgery to assess any shifts in the position of the tumor. Neurosurgeons are able to see a three dimensional (3D) model of the tumor and change their surgical approach accordingly for the patient’s safety.11 5-Aminolevulinic acid is another method used by neurosurgeons to guide surgeries utilizing its fluorescence as a marker. Using violet-blue excitation light, neurosurgeons are able to detect the fluorescent margins of the tumor to assure safe resection.12 Moreover, new and improved robotics such as the NeuroArm© can be even more precise than a human hand when incising the margins of a tumor, further decreasing the possibility of damage to the surrounding tissues, thus protecting against neurological deficits.13