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Neurosurgical Techniques and Strategies
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Jonathan E. Martin, Ian F. Pollack, Robert F. Keating
Availability of intraoperative adjuncts requires prior planning.55 Frameless stereotactic navigation allows for optimized surgical planning, including incision and bone flap placement as well as localization of deep-seated pathology. Ultrasound provides real-time assessment of anatomy within the working field and beyond. It can be used to assess tumor and ventricular location, and evaluate the extent of resection. Intraoperative MRI (Figure 6.6) provides near-time assessment of exquisite cross-sectional anatomic detail, minimizes need for return to the operating room for residual disease, and allows for optimal resection of infiltrative tumors.56 Intraoperative neuromonitoring of modalities, to include brainstem auditory evoked responses, motor evoked potentials, and somatosensory evoked potentials, provides functional feedback during the case, and requires careful coordination with anesthesia to achieve optimal results.57,58 Finally, in children with intractable seizures from cerebral neoplasms, intraoperative or extraoperative electrocorticography (ECOG)59 may be used to define areas of epileptogenic cortex in and around the tumor to increase the likelihood that seizure control will be obtained postoperatively. Recently the use of intraoperative MRI has increased seizure control in patients with cortical dysplasias.60
Neurosurgery: Minimally invasive neurosurgery
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Charu Mahajan, Indu Kapoor, Hemanshu Prabhakar
The endoscopic approach has taken over the earlier microscopic approach for resection of pituitary tumors. Computer-assisted navigation uses co-registration of the patient points on preoperative MRI images, which helps in directing the trajectory toward the focus. A small flexible endoscope is inserted through a nasal cavity toward the tumor base, followed by lateralization of turbinates and sphenoidotomy to reach the sella. An extended approach may be required for removal of parasellar or suprasellar tumors. Intraoperative MRI provides information about the tumor remnants, enabling its more thorough removal and also helps in detection of any hematomas. The main advantages of an endoscopic approach are broader, clearer field visualization and ability to see hidden areas which usually remain inaccessible when using a microscope. Other advantages are less pain, shorter operative times, better airflow, earlier recovery, shorter hospital stay, and better short-term sinonasal quality of life and endocrinological outcome (1–4). Although the evidence varies regarding long-term sinonasal quality, the recent trend is more toward the endoscopic approach.
Neurosurgery
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Intraoperative MRI (iMRI) during neurosurgical procedures offers near real-time imaging surgical guidance. Intraoperative scanning allows the surgeon to scan the patient at an appropriate time during surgery and then conclude the surgical procedure or perform further resection. This approach is associated with improved clinical outcomes and, if repeated operations can be avoided, economic savings.
The effect of thermal therapy on the blood-brain barrier and blood-tumor barrier
Published in International Journal of Hyperthermia, 2020
Bhuvic Patel, Peter H. Yang, Albert H. Kim
A LITT procedure is performed in conjunction with intraoperative MRI. Once the patient is placed under general anesthesia and intubated, the head is fixed in a rigid skull clamp and registered to a frameless stereotactic navigation system to plan the burr hole and trajectory of the laser probe. A skin incision and bur hole are made, after which the laser probe is inserted using stereotactic navigation. The patient’s head is then placed within the MRI bore with the probe in place (Figure 2(A)). An MRI scan is performed, allowing for monitoring of the position of the probe, which can be advanced or withdrawn during the procedure. Additionally, firing of the laser probe is interleaved with acquisition of MR images in real time. This information is integrated by a computer connected to the MRI scanner, allowing for measurement of tissue temperature using MR thermometry (Figure 2(B)). Using this technique, tissue temperature can be measured to within 1 °C with a spatial resolution of 1–2 mm [15,65]. Importantly, this allows for measurement of temperatures distant from the laser probe, allowing for ablation of the target lesion while sparing normal tissue. Using the Arrhenius equation, which predicts cell death as a function of tissue temperature and ablation time, the computer is able to display zones of tissue damage to ensure adequate ablation of the target lesion [65,70,75].
Cranial neurosurgical robotics
Published in British Journal of Neurosurgery, 2021
Rami Elsabeh, Sukhbir Singh, Jeff Shasho, Yoni Saltzman, John M. Abrahams
In developing a robot, if similar to the NeuRobot or Da Vinci, the size of the arm and accompanying camera pose a key problem in fitting the necessary robot into a small enough opening. The success of the da Vinci system is partly because there is enough volume to manipulate instruments within an insufflated abdomen. Visualization is a requirement in that the Neurosurgeon operator needs proper viewing at all times; current endoscopes would not suffice to satisfy said specifications. Furthermore, in the example of the NeuroArm, the requirement of having an intraoperative MRI (iMRI) has potentially slowed the incorporation of this robotic system. The slow adoption of the Neuroarm could be directly related to a slow adoption of the iMRI.
Application of intra-operative magnetic resonance imaging for intracranial epidermoid cysts
Published in British Journal of Neurosurgery, 2023
Akihide Kondo, Osamu Akiyama, Shigeki Aoki, Hajime Arai
About 20 years have passed since Steinmeier et al.1 reported the application of intra-surgical magnetic resonance imaging (MRI) to neurosurgery. Since then, this approach has been applied in various forms and it has become clear that intraoperative MRI (iMRI) is safe and effective for the treatment of intracranial tumours.2 The evidence level is especially high for the effectiveness of iMRI with respect to gliomas.3 According to Fahlbusch and Sami,2 the use of iMRI increases the tumour removal rate and produces statistically significant increases in overall survival (OS) and progression-free survival (PFS).4 Thus, iMRI may become a required technique for glioma surgery.5