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History of Brain Mapping and Neurophotonics
Published in Yu Chen, Babak Kateb, Neurophotonics and Brain Mapping, 2017
Babak Kateb, Frank Boehm, Alexandra Jalali, Vassiliy Tsytsarev, Vicky Yamamoto, Bahram Jalali, Derek Backer, Brian Pikul, Parham Yashar, Yu Chen
The Intraoperative Magnetic Resonance Imaging Integrated Neurosurgical Suite (IMRIS) produced by IMRIS, Deerfield Imaging (Minnetonka, MN, USA), provides a seamlessly integrated intraoperative imaging platform, wherein MRI and CT scanners are mounted on ceiling rails, which negates the necessity of moving or repositioning the patient. Hence, on-demand real-time imaging is available at any point, prior to surgical procedures, or at any time during or following surgeries. In addition, the integrity of the sterilized surgical field remains intact, as do the capacities for anesthesia and patient monitoring. On the basis of increasing validity revealed in clinical publications, there is strong support for IMRIS iMRI in terms of its safety and utility toward the optimization of intraoperative brain tumor removal. This system enables the capacity for minimally invasive neurosurgery, inclusive of epilepsy-associated thermal ablation, lead device positioning to facilitate deep brain stimulation, and the mediation of “tumor resection with fiber tracking for arteriovenous malformation and aneurysms” (IMRIS, 2016).
Neurosurgical intraoperative ultrasonography using contrast enhanced superb microvascular imaging -vessel density and appearance time of the contrast agent-
Published in British Journal of Neurosurgery, 2023
Mami Ishikawa, Kazuto Masamoto, Ryota Hachiya, Hiroshi Kagami, Makoto Inaba, Heiji Naritaka, Shojiro Katoh
Intraoperative ultrasonography (US) has been used for a few decades as an imaging modality during neurosurgical operations.1–6 The main advantages of intraoperative neurosurgical US are as follows: (1) provision of real-time scanning with animated images; (2) scans can be obtained as often as needed; and (3) imaging is cheaper than intraoperative magnetic resonance imaging (MRI). The main disadvantage of intraoperative US is the low spatial resolution. However, real-time animated images with the latest US techniques can provide operative information compensating for this disadvantage. One recent innovative technique is superb microvascular imaging (SMI) (Canon Medical Systems, Tokyo, Japan). We have reported the excellent sensitivity and utility of SMI for US monitoring during neurosurgery.7 The imaging features of US with SMI are as follows: (1) visualization of low-velocity flow with minimal motion artifacts; (2) high resolution; and (3) high frame rates. We have reported the characteristics of vessels in different tumors using SMI, such as rounded and dilated vessels in glioblastomas and numerous branching vessels in meningiomas. Another innovative US imaging technique is intraoperative animated monitoring using administration of contrast agent during brain tumor surgery.1,3,5,8–11
Cranial neurosurgical robotics
Published in British Journal of Neurosurgery, 2021
Rami Elsabeh, Sukhbir Singh, Jeff Shasho, Yoni Saltzman, John M. Abrahams
NeuroArm (Figure 4) is a teleoperated surgical robotic system (http://www.neuroarm.org/) to allow operating with real-time intraoperative magnetic resonance imaging (MRI).46,47 NeuroArm was successfully manufactured and installed into intraoperative MRI room and was used in 35 cases.3 The device is MRI-compatible and image-guided made of two PEEK (poly-ether-ether-ketone) robotic arms capable of manipulating microsurgical tools such as a bipolar and special grabbing device. At the workstation, a human-device interface provides both MRI data and real-time high definition 3D images of the surgical site. Haptic feedback is relayed to the surgeon through the hand controls. In the most recent publication, the group attempted to correlate tissue pathology in brain tumors to force exerted on the NeuroArm robotic arms without success.48
Contemporary surgical management of drug-resistant focal epilepsy
Published in Expert Review of Neurotherapeutics, 2020
Jasmina R. Milovanović, Slobodan M. Janković, Dragan Milovanović, Dejana Ružić Zečević, Marko Folić, Marina Kostić, Goran Ranković, Srđan Stefanović
The economic evaluations carried out on pediatric patients with focal drug-resistant epilepsy also suggest that surgery could be a cost-saving option compared to medical treatment [144–146]. This is not surprising since children are more suitable for surgical treatment due to generally better clinical outcomes and lower treatment costs [144,147]. In the light of the aforementioned, Widjaja et al found surgical management to be more expensive, but also more effective than continuous drug therapy, ascertaining the incremental cost-effectiveness ratio (ICER) of surgery to be $28.264 per seizure freedom achieved during 12 months of follow-up [145]; the net monetary benefit was positive in this study. In another Canadian study, value of ICER ranged from $19.079 to $52.961, if the same follow-up period (one year) was taken into account [144]. New approach to surgical resection of epileptic foci (intraoperative magnetic resonance imaging (iMRI) versus conventional microsurgical techniques) resulted on the long run with higher frequency of seizure freedom and lower direct medical costs in children with epilepsy when compared to conventional methods [148].