Electromagnetic-guided neuroendoscopy in the pediatric population

Sangra, Meharpal; Clark, Simon; Hayhurst, Caroline; Mallucci, Conor

doi:10.3171/2008.12.peds0888

Cited by 44 publications

(35 citation statements)

References 23 publications

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“…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]. While it was shown to be beneficial especially in the placement of ventricular catheters for different indications [23,24,31,33,43,44], its advantages have been demonstrated also for many other neurosurgical procedures [22,25,26,27,34,45,46,47]. Studies on the accuracy of EM navigation have shown that it is comparable to optoelectric navigation ranging between 0.71-3.51 mm [48] and 0.7-4.4 mm [49].…”

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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“…Despite the well-documented application of nonrobotic stereotactic approaches in neuroendoscopy, 46,53,55 we opted for the robotic assistance to validate this technique in easier cases, (e.g., third ventriculostomy for obstructive hydrocephalus), especially at the beginning of our experience. More recently, we progressively changed the indications to more complex cases.…”

Section: Endoscopy-guided Proceduresmentioning

confidence: 99%

Robot-assisted procedures in pediatric neurosurgery

Benedictis¹,

Trezza

Carai³

et al. 2017

Neurosurgical Focus

144

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OBJECTIVEDuring the last 3 decades, robotic technology has rapidly spread across several surgical fields due to the continuous evolution of its versatility, stability, dexterity, and haptic properties. Neurosurgery pioneered the development of robotics, with the aim of improving the quality of several procedures requiring a high degree of accuracy and safety. Moreover, robot-guided approaches are of special interest in pediatric patients, who often have altered anatomy and challenging relationships between the diseased and eloquent structures. Nevertheless, the use of robots has been rarely reported in children. In this work, the authors describe their experience using the ROSA device (Robotized Stereotactic Assistant) in the neurosurgical management of a pediatric population.METHODSBetween 2011 and 2016, 116 children underwent ROSA-assisted procedures for a variety of diseases (epilepsy, brain tumors, intra- or extraventricular and tumor cysts, obstructive hydrocephalus, and movement and behavioral disorders). Each patient received accurate preoperative planning of optimal trajectories, intraoperative frameless registration, surgical treatment using specific instruments held by the robotic arm, and postoperative CT or MR imaging.RESULTSThe authors performed 128 consecutive surgeries, including implantation of 386 electrodes for stereo-electroencephalography (36 procedures), neuroendoscopy (42 procedures), stereotactic biopsy (26 procedures), pallidotomy (12 procedures), shunt placement (6 procedures), deep brain stimulation procedures (3 procedures), and stereotactic cyst aspiration (3 procedures). For each procedure, the authors analyzed and discussed accuracy, timing, and complications.CONCLUSIONSTo the best their knowledge, the authors present the largest reported series of pediatric neurosurgical cases assisted by robotic support. The ROSA system provided improved safety and feasibility of minimally invasive approaches, thus optimizing the surgical result, while minimizing postoperative morbidity.

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“…The electromagnetic tracking system can operate continuously for realtime localization. 2,5,21) Optical tracking systems can be interrupted by instruments (i.e., the operating microscope) blocking the light line between the optical camera and light-emitting diode. 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.…”

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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Electromagnetic-guided neuroendoscopy in the pediatric population

Cited by 44 publications

References 23 publications

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Robot-assisted procedures in pediatric neurosurgery

Newly Developed Electromagnetic Tracked Flexible Neuroendoscope -Technical Note-

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