Intraoperative Imaging in Neurosurgery: Where Will the Future Take Us?

Jólesz, Ferenc A.

doi:10.1007/978-3-211-99651-5_4

Cited by 46 publications

(18 citation statements)

References 50 publications

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“…Intraoperative MRI has been adapted from the field of neurosurgery, and it involves the use of ultra-high field 3T MRI scanners[51]. Within the spine literature, few studies exist regarding the safety and efficacy of intraoperative MRI.…”

Section: Intraoperative Three-dimensional Imaging and Spinal Navigatimentioning

confidence: 99%

Radiation exposure and reduction in the operating room: Perspectives and future directions in spine surgery

Narain

Hijji

Yom

et al. 2017

WJO

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Intraoperative imaging is vital for accurate placement of instrumentation in spine surgery. However, the use of biplanar fluoroscopy and other intraoperative imaging modalities is associated with the risk of significant radiation exposure in the patient, surgeon, and surgical staff. Radiation exposure in the form of ionizing radiation can lead to cellular damage via the induction of DNA lesions and the production of reactive oxygen species. These effects often result in cell death or genomic instability, leading to various radiation-associated pathologies including an increased risk of malignancy. In attempts to reduce radiation-associated health risks, radiation safety has become an important topic in the medical field. All practitioners, regardless of practice setting, can practice radiation safety techniques including shielding and distance to reduce radiation exposure. Additionally, optimization of fluoroscopic settings and techniques can be used as an effective method of radiation dose reduction. New imaging modalities and spinal navigation systems have also been developed in an effort to replace conventional fluoroscopy and reduce radiation doses. These modalities include Isocentric Three-Dimensional C-Arms, O-Arms, and intraoperative magnetic resonance imaging. While this influx of new technology has advanced radiation safety within the field of spine surgery, more work is still required to overcome specific limitations involving increased costs and inadequate training.

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Section: Intraoperative Three-dimensional Imaging and Spinal Navigatimentioning

confidence: 99%

Radiation exposure and reduction in the operating room: Perspectives and future directions in spine surgery

Narain

Hijji

Yom

et al. 2017

WJO

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“…11,19,20,25 Full biplane neuroangiography in a fully equipped neurosurgical operating room provides a seamless transition between the operation and iDSA, which can be performed without repositioning the patient or moving in a portable C-arm. The result is higher-quality angiography in 2 planes, which provides immediate intraoperative assessment of vessel patency and occlusion rate of different vascular pathological entities.…”

Section: Hybrid Operating Room: Applications In Ich Surgerymentioning

confidence: 99%

“…Examples are the Advanced Multimodality Image-Guided Operating (A.M.I.G.O.) Suite at the Brigham and Women's Hospital and Harvard Medical School 20 and the implementation of so-called IMRIS suites (IMRIS, Inc.) at various locations internationally. 25 These systems are able to integrate a 1.5-to 3-T iMRI unit into a fully operational neurosurgical operating room and a full biplane angiography suite.…”

Section: Hybrid Operating Room: Applications In Ich Surgerymentioning

confidence: 99%

Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage

Goren

Monteith

Hadani

et al. 2013

FOC

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This paper reviews the current intraoperative imaging tools that are available to assist neurosurgeons in the treatment of intracerebral hemorrhage (ICH). This review shares the authors' experience with each modality and discusses the advantages, potential limitations, and disadvantages of each. Surgery for ICH is directed at blood clot removal, reduction of intracranial pressure, and minimization of secondary damage associated with hematoma breakdown products. For effective occlusion and safe obliteration of vascular anomalies associated with ICH, vascular neurosurgeons today require a thorough understanding of the various intraoperative imaging modalities available for obtaining real-time information. Use of one or more of these modalities may improve the surgeon's confidence during the procedure, the patient's safety during surgery, and surgical outcome. The modern techniques discussed include 1) indocyanine green–based video angiography, which provides real-time information based on high-quality images showing the residual filling of vascular pathological entities and the patency of blood vessels of any size in the surgical field; and 2) intraoperative angiography, which remains the gold standard intraoperative diagnostic test in the surgical management of cerebral aneurysms and arteriovenous malformations. Hybrid procedures, providing multimodality image-guided surgeries and combining endovascular with microsurgical strategies within the same surgical session, have become feasible and safe. Microdoppler is a safe, noninvasive, and reliable technique for evaluation of hemodynamics of vessels in the surgical field, with the advantage of ease of use. Intraoperative MRI provides an effective navigation tool for cavernoma surgery, in addition to assessing the extent of resection during the procedure. Intraoperative CT scanning has the advantage of very high sensitivity to acute bleeding, thereby assisting in the confirmation of the extent of hematoma evacuation and the extent of vascular anomaly resection. Intraoperative ultrasound aids navigation and evacuation assessment during intracerebral hematoma evacuation surgeries. It supports the concept of minimally invasive surgery and has undergone extensive development in recent years, with the quality of ultrasound imaging having improved considerably. Image-guided therapy, combined with modern intraoperative imaging modalities, has changed the fundamentals of conventional vascular neurosurgery by presenting real-time visualization of both normal tissue and pathological entities. These imaging techniques are important adjuncts to the surgeon's standard surgical armamentarium. Familiarity with these imaging modalities may help the surgeon complete procedures with improved safety, efficiency, and clinical outcome.

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“…Magnetic Resonance Imaging (MRI) offers high-resolution tissue imaging at arbitrary orientations and is also able to monitor therapeutic agents, surgical tools, tissue properties, and physiological function, which make MRI uniquely suitable for guiding, monitoring and controlling a wide array of localized interventions [1]. Nevertheless, the limited space inside the bore is typically 60–70 cm in diameter and 170 cm in length.…”

Section: Introductionmentioning

confidence: 99%

Piezoelectrically Actuated Robotic System for MRI-Guided Prostate Percutaneous Therapy

Shang

Cole

et al. 2015

IEEE/ASME Trans. Mechatron.

113

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This paper presents a fully-actuated robotic system for percutaneous prostate therapy under continuously acquired live magnetic resonance imaging (MRI) guidance. The system is composed of modular hardware and software to support the surgical workflow of intra-operative MRI-guided surgical procedures. We present the development of a 6-degree-of-freedom (DOF) needle placement robot for transperineal prostate interventions. The robot consists of a 3-DOF needle driver module and a 3-DOF Cartesian motion module. The needle driver provides needle cannula translation and rotation (2-DOF) and stylet translation (1-DOF). A custom robot controller consisting of multiple piezoelectric motor drivers provides precision closed-loop control of piezoelectric motors and enables simultaneous robot motion and MR imaging. The developed modular robot control interface software performs image-based registration, kinematics calculation, and exchanges robot commands and coordinates between the navigation software and the robot controller with a new implementation of the open network communication protocol OpenIGTLink. Comprehensive compatibility of the robot is evaluated inside a 3-Tesla MRI scanner using standard imaging sequences and the signal-to-noise ratio (SNR) loss is limited to 15%. The image deterioration due to the present and motion of robot demonstrates unobservable image interference. Twenty-five targeted needle placements inside gelatin phantoms utilizing an 18-gauge ceramic needle demonstrated 0.87 mm root mean square (RMS) error in 3D Euclidean distance based on MRI volume segmentation of the image-guided robotic needle placement procedure.

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Intraoperative Imaging in Neurosurgery: Where Will the Future Take Us?

Cited by 46 publications

References 50 publications

Radiation exposure and reduction in the operating room: Perspectives and future directions in spine surgery

Radiation exposure and reduction in the operating room: Perspectives and future directions in spine surgery

Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage

Piezoelectrically Actuated Robotic System for MRI-Guided Prostate Percutaneous Therapy

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