Application of electromagnetic technology to neuronavigation: a revolution in image-guided neurosurgery

Hayhurst, Caroline; Byrne, Patricia; Eldridge, Paul; Mallucci, Conor

doi:10.3171/2008.12.jns08628

Cited by 85 publications

(68 citation statements)

References 19 publications

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“…The advent of EM navigation has been termed a revolution in frameless navigation, and it certainly has various advantages [42]. It obviates the need for sharp head fixation offering a good alternative to optoelectric techniques, there are no line-of-sight problems, the position of the patient can be changed during surgery, and it allows the use of flexible instruments [24,31,33].…”

Section: Discussionmentioning

confidence: 99%

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Hermann¹,

Polemikos²,

Heissler³

et al. 2017

Stereotact Funct Neurosurg

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Background: Idiopathic intracranial hypertension (IIH) is characterized by increased cerebrospinal fluid (CSF) pressure and normal or slit ventricles. Lumboperitoneal shunting had been favored by many investigators for CSF diversion in IIH for decades; however, it has been associated with various side effects. Because of the small ventricular size adequate positioning of a ventricular catheter is challenging. Objectives: Here, we investigated the usefulness of electromagnetic (EM)-guided ventricular catheter placement for ventriculoperitoneal shunting in IIH. Methods: Eighteen patients with IIH were included in this study. The age of patients ranged from 5 to 58 years at the time of surgery (mean age: 31.8 years; median: 29 years). There were 2 children (5 and 11 years old) and 16 adults. Inclusion criteria for the study were an established clinical diagnosis of IIH, lack of improvement with medication, and the presence of small ventricles. In all patients EM-navigated placement of the ventricular catheter was performed using real-time tracking of the catheter tip for exact positioning close to the foramen of Monro. Postoperative CT scans were correlated with intraoperative screen shots to validate the position of the catheter. Results: In all patients EM-navigated ventricular catheter placement was achieved with a single pass. There were no intraoperative or postoperative complications. Postoperative imaging confirmed satisfactory positioning of the ventricular catheter. No proximal shunt failure was observed during the follow-up at a mean of 41.5 months (range: 7-90 months, median: 40.5 months). Conclusions: EM-navigated ventricular catheter placement in shunting for IIH is a safe and straightforward technique. It obviates the need for sharp head fixation, the head of the patient can be moved during surgery, and it may reduce the revision rate during follow-up.

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Section: Discussionmentioning

confidence: 99%

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Hermann¹,

Polemikos²,

Heissler³

et al. 2017

Stereotact Funct Neurosurg

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“…Electromagnetic tracking systems offer many advantages over optical tracking systems, especially in the field of pediatric neurosurgery, such as for insertion of ventriculoperitoneal shunts, electromagnetic navigation-assisted rigid endoscopic procedures, and intraventricular catheter placement. 7,15,19,23) Electromagnetic navigation systems were created in 1991, with a computer-assisted neurosurgical navigational system using a magnetic source and sensor. 12) Since then, many in vivo and in vitro uses have been reported, and registration error as calculated by the various systems currently varies between 0.7 mm and 4.4 mm, showing no difference in accuracy compared with current optical navigation systems.…”

Section: Discussionmentioning

confidence: 99%

Newly Developed Electromagnetic Tracked Flexible Neuroendoscope -Technical Note-

Atsumi

Matsumae

Hirayama

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Flexible endoscopes can be used in areas that are difficult to approach using rigid endoscopes. No current real-time navigation systems identify the tip of the flexible neuroendoscope. We have developed a flexible neuroendoscope mounted with a magnetic field sensor tip position-tracking system and evaluated the accuracy of this magnetic field neuronavigation system. Based on an existing flexible neuroendoscope, we created a prototype with a built-in magnetic field sensor in the tip. A magnetic field measurement device provides a magnetic field with a working volume of 500 × 500 × 500 mm in front of the device. The device consists of a flat field generator that creates a pulsed magnetic field, connected to a system control unit that interfaces with a computer. The magnetic field sensor (1.8 × 9 mm) was sealed in a site 0.9 mm from the endoscope tip. Accuracy of neuroendoscope tracking was measured using a three-dimensional coordinate-measuring machine that measures the position of objects along 3 axes, with an error of about 3 mm. The accuracy for this neuroendoscope with built-in magnetic field sensor was root mean square error of 1.2 mm and standard deviation of 0.5 mm. This magnetic field neuronavigation system enables real-time tracking of the tip of the flexible neuroendoscope. Application of this flexible neuroendoscope to intraoperative navigation appears promising, and may provide new advantages for minimally invasive endoscopic surgery.

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“…The malplacement rate and complication rate was significantly reduced (2,10). It is particularly useful in patients with distorted anatomy and slit ventricle where the system is able to guide the direction and depth of EVD insertion.…”

Section: A B D C Chai Fy Et Al: Coma Due To Malplaced External Ventrmentioning

confidence: 97%

“…This technique requires 3 mm CT brain data set or MRI images and an image guidance system in operating theatre. Hence, it maybe more time consuming compared to the free-hand technique (2). However, the time consumed may be compensated by the time gained by reducing the number of passes, which might also reduce brain injury (10).…”

Section: A B D C Chai Fy Et Al: Coma Due To Malplaced External Ventrmentioning

confidence: 99%

Coma due to malplaced external ventricular drain

Chai

Fadzil²,

Thanabalan³

2012

Turkish Neurosurgery

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Ventriculostomy or external ventricular drain (EVD) placement by free-hand technique has a high malplacement rate. It is a blind procedure that often requires multiple attempts and revisions. To date, no neurological complication due to EVD malplacement has been reported in the literature. In this report, we present the first case of coma induced by a malplaced EVD and the patient regained consciousness after the drain was adjusted. Our discussion focused on various techniques that can improve the accuracy of EVD insertion. EVD insertion under image guidance provides better accuracy with limited disadvantages. We hypothesized that the patient's coma was due to the mass effect and irritation of the malplaced EVD exerted onto the ventral periaqueductal grey matter and the ascending neurons from upper brainstem. KeywOrds: Coma, Complications, External ventricular drain, Ventriculostomy, Hydrocephalus ÖZVentrikülostomi veya serbest eksternal ventriküler dren (EVD) yerleştirmenin yüksek bir yanlış yerleştirme oranı mevcuttur. Bu kör işlem çok sayıda girişim ve revizyon gerektirir. Günümüze kadar EVD yanlış yerleştirilmesi nedeniyle literatürde bir nörolojik komplikasyon bildirilmemiştir. Bu raporda, yanlış yerleştirilen EVD nedeniyle oluşan ilk koma vakasını sunuyoruz. Hastanın bilinci dren ayarlanırken tekrar yerine gelmiştir. Tartışmamız EVD insersiyonunun doğruluğunu arttırabilecek çeşitli tekniklere odaklanmaktadır. Görüntüleme kılavuzluğu altında EVD insersiyonu daha yüksek doğruluğa sahiptir ve dezavantajları sınırlıdır. Hastanın komasının yanlış yerleştirilen EVD'nin ventral periakuaduktal gri madde ve üst beyin kökünün çıkan nöronları üzerinde oluşturduğu kitle etkisi ve irritasyon sonucu oluştuğunu düşünmekteyiz.

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Application of electromagnetic technology to neuronavigation: a revolution in image-guided neurosurgery

Cited by 85 publications

References 19 publications

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Newly Developed Electromagnetic Tracked Flexible Neuroendoscope -Technical Note-

Coma due to malplaced external ventricular drain

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