Experience with a New Multifunctional Articulated Instrument Holder in Minimally Invasive Navigated Neurosurgery

Reinges, M. H. T.; Spetzger, Uwe; Rohde, Veit; Adams, L.; Gilsbach, Joachim M.

doi:10.1055/s-2008-1052032

Cited by 15 publications

(8 citation statements)

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“…The development of frameless stereotactic systems and their widespread introduction into the operating room presently enable neurosurgeons to locate small and deep-seated tumors during surgery with a precision of approximately 2 mm [10,11,12,13]. The introduction in 1993 of functional imaging of the brain combined with intraoperative neuronavigation represented a big advance in the safety of neurosurgery [14].…”

Section: Discussionmentioning

confidence: 99%

Practicability of magnetoencephalography-guided neuronavigation

et al. 2002

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Magnetoencephalography (MEG) is a noninvasive option for localizing electroneurophysiological activity on the human cortex. The purpose of this study was to evaluate the practicability and reliability of MEG imaging integrated into a neuronavigation system to identify the sensorimotor cortex intraoperatively in patients with brain tumors in or near the central motor strip. It was performed prior to surgery in 30 patients with space-occupying lesions in or around the central region to localize the primary somatosensory cortex. These functional brain maps were superimposed on MR images obtained prior to surgery and transferred in the operating room for intraoperative functional neuronavigation. During surgery, the phase reversal technique identified a generator which coincided with the somatosensory cortex as displayed by the MEG-based functional neuronavigation system. Following surgery, the motor deficit improved in seven patients, was unchanged in five, and showed a slight transient deterioration in five. One patient suffered a deterioration of motor function with incomplete recovery. The MEG-based functional neuronavigation was found to be practicable and useful in finding a safe approach to tumors in or adjacent to the central region. The accuracy of MEG was concluded to be reliable as verified by the phase reversal technique.

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Section: Discussionmentioning

confidence: 99%

Practicability of magnetoencephalography-guided neuronavigation

et al. 2002

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“…Before draping, a frameless stereotactic device (EasyGuide Neuro system, Philips Medical Systems, Best, The Netherlands) was used in 22 of the 25 patients to define the appropriate burr hole site and the optimal trajectory to the floor of the third ventricle [10]. During the whole procedure, the trajectory of the rigid endoscope (Aesculap AG, Tuttlingen, Germany) was maintained by an articulated arm [11]. The floor of the third ventricle was perforated in the midline anterior to the mamillary bodies close to the clivus either by bipolar coagulation (first 5 cases) or by twisting and slightly pushing the tip of the Fogarty catheter.…”

Section: Operationsmentioning

confidence: 99%

Anomalies and Variants of the Endoscopic Anatomy for Third Ventriculostomy

Rohde¹,

Gilsbach²

2000

Minim Invasive Neurosurg

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Anatomic anomalies are a frequent finding during ETV. Successful perforation and control of the hydrocephalus correlates with the absence of anatomic anomalies. Most anatomic variants have the potential to increase the operative risk. With the exception of the thickened third ventricular floor, MR imaging allows us to identify all anatomic anomalies preoperatively, and enables the neurosurgeon to weigh the operative risk in a patient with an anatomic anomaly against the chance to perform ETV successfully.

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“…The overall scheme is fairly simple compared to traditional stereotactic headframes or other neuronavigation systems. [11][12][13][14][15][16][17][18][19][20] Furthermore, using the near-real-time image-based feedback, the neurosurgeons can verify the exact alignment of the guidance device immediately before proceeding with needle introduction after the alignment procedure, and can later monitor the position of the needle during the insertion process. This not only assures that the needle is indeed being advanced to the correct target location, but also documents that the final needle tip location is inside the tumor volume.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] So far, most of these approaches, whether frame-based [1][2][3][4][5][6][7][8][9][10] or frameless, [11][12][13][14][15][16][17][18][19][20] have been retrospective in essence, because they all rely on three-dimensional (3D) image data acquired prior to surgery for targeting and anatomical registration. In a typical brain biopsy procedure, all consequent target localization and trajectory determination is based on the retrospective data set.…”

Section: Introductionmentioning

confidence: 99%

“…The ability to choose an optimal incision site on the scalp, accurately align the biopsy needle toward the targeted lesion immediately prior to insertion, and monitor the needle introduction are all essential to minimizing the invasiveness of the procedure. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] In a typical neurosurgical environment where both intelligent human decisions and accuracy are simultaneously required, an effective and acceptable approach must balance the two important elements without compromising the outcome of the surgery. Following this concept, a practical surgical guidance scheme must be both accurate and simple.…”

Section: Introductionmentioning

confidence: 99%

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Remotely-controlled approach for stereotactic neurobiopsy

Liu

Hall

Truwit

2002

Comput. Aided Surg.

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The objective of this study was to develop, demonstrate, and validate a remotely controlled operation scheme coupled with prospective magnetic resonance imaging (MRI)-based stereotaxy for in vivo neurosurgical applications. The novel concept of the prospective guidance scheme is to employ tomographical imaging feedback, such as MRI or CT, to facilitate prospectively the targeting process of a biopsy needle at near-real-time speed (1 image/s). Because the orientation of a biopsy needle pivoted at an entry point on the patient's skull has 2 degrees of freedom, the alignment of its trajectory to a target point can be guided by two-dimensional (2D) images whose plane is placed perpendicular to the desired trajectory. Using near-real-time 2D visual feedback during the adjustment of the alignment guide, the required trajectory alignment can be translated into a simple targeting task on a computer monitor employing a suitable graphic presentation. Also, both adjustments for the alignment and introduction of the biopsy needle were accomplished remotely with image-based feedback. The use of the method in actual MR-guided brain lesion biopsy procedures at 1.5 T showed an improved tissue yield due to the improved targeting accuracy even in the presence of brain shift. Furthermore, the postalignment trajectory can be validated immediately using near-real-time MRI scans in two orthogonal views before needle insertion. Because the final needle position is always visualized and confirmed, the consequent tissue sampling is performed with greater certainty, even in the case of a negative diagnosis. The actual targeting error was 1.53 +/- 0.17 mm from an intended target location, with the maximum distance error of 1.72 mm at a depth of 85 mm. This remotely controlled surgical approach with intraoperative MRI guidance is feasible at 1.5 T, and has allowed neurosurgeons to perform neurobiopsies comfortably and efficiently in a routine clinical MR scanner. This scheme provides a unique alternative stereotactic procedure that can take full advantage of the prospective guidance potential offered by various modern tomographic imaging systems.

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Experience with a New Multifunctional Articulated Instrument Holder in Minimally Invasive Navigated Neurosurgery

Cited by 15 publications

References 0 publications

Practicability of magnetoencephalography-guided neuronavigation

Practicability of magnetoencephalography-guided neuronavigation

Anomalies and Variants of the Endoscopic Anatomy for Third Ventriculostomy

Remotely-controlled approach for stereotactic neurobiopsy

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