Magnetically Guided Neuronavigation of Flexible Instruments in Shunt Placement, Transsphenoidal Procedures, and Craniotomies

Schichor, Christian; Witte, Jens; Schöller, Karsten; Tanner, P.; Uhl, Eberhard; Goldbrunner, Roland; Tonn, Jörg‐Christian

doi:10.1227/01.neu.0000297082.28670.b1

Cited by 9 publications

(5 citation statements)

References 16 publications

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“…Published single-institution case series from our group 3,6 and others 1,10,12,14 have demonstrated the utility of noninvasive EM navigation in accurately placing ventricular catheters. Azeem and Origitano 1 reported on a retrospective series of 34 ventricular catheters placed using EM guidance, of which 24 were routine ventriculoperitoneal shunt procedures with enlarged ventricles.…”

Section: Discussionmentioning

confidence: 89%

Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study

Hayhurst

Beems

Jenkinson

et al. 2010

JNS

106

105

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Section: Discussionmentioning

confidence: 89%

Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study

Hayhurst

Beems

Jenkinson

et al. 2010

JNS

106

105

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“…Endovascular devices enabled with medical GPS-like positioning and tracking technology allow the interventional operator to reference pre-procedural imaging in real time. Such technology can bring multiple modalities together in different combinations and timing, when clinically needed (11-13) to procedural areas normally devoid of this information. Stent graft deployment is one possible clinical application for this paradigm.…”

Section: Discussionmentioning

confidence: 99%

“…Electromagnetic navigation systems have been increasingly implemented in surgical applications (9, 11). These navigation systems enable precise positioning and orientation of surgical, endoscopic, and interventional devices in patients, by referencing advanced imaging modalities usually not available in the procedure room.…”

Section: Introductionmentioning

confidence: 99%

Electromagnetic Navigation for Thoracic Aortic Stent-graft Deployment: A Pilot Study in Swine

Abi-Jaoudeh¹,

Glossop²,

Dake³

et al. 2010

Journal of Vascular and Interventional Radiology

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Purpose The goal of this study was to determine the feasibility of electromagnetic tracking as a method to augment conventional imaging guidance for the safe delivery, precise positioning, and accurate deployment of thoracic aortic endografts. Materials & Methods Custom guidewires were fabricated and the delivery catheters for thoracic aortic endoprostheses (Gore TAG endoprostheses, W.L. Gore & Assoc. Inc., Flagstaff AZ) were retrofitted with integrated electromagnetic coil sensors enabling realtime endovascular tracking. Pre-procedure thoracic CTA were obtained after placement of fiducial skin patches on the chest wall of three anesthetized swine, enabling automatic registration. The stent graft deployment location target near the subclavian artery was selected on the pre-procedure CTA. Two steps were analyzed: advancing a tracked glidewire to the aortic arch, and positioning the tracked stent graft assembly using electromagnetic guidance alone. Multiple CT scans were performed to evaluate the accuracy of the electromagnetic tracking system by measuring the target registration error which compared the actual position of the tracked devices to the displayed “virtual” electromagnetic-tracked position. Post-deployment CTA and necropsy confirmed stent graft position and subclavian artery patency. Results A stent graft was successfully delivered and deployed in each of the three animals using real-time electromagnetic tracking alone. The mean of the fiducial registration error of the auto-registration was 1.5 mm. Sixteen comparative scans were obtained to determine the target registration error, which was 4.3mm ± 0.97 mm (Range: 3.0 to 6.0mm) for the glidewire sensor coil. The target registration error for the stent graft delivery catheter sensor coil was 2.6 mm ± 0.7 mm (Range: 1.9 to 3.8 mm). The deployment error for the stent graft defined as deployment deviation from target was 2.6mm ± 3.0 mm. Conclusion Delivery and deployment of customized thoracic stent grafts is feasible and accurate in swine using electromagnetic tracking alone. Combining endovascular electromagnetic tracking with conventional fluoroscopy may further improve accuracy and be a more realistic multi-modality approach.

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“…24 Advances in neuronavigation including refinement of magnetic field based flexible stereotactic probes may allow more precise navigated placement of strip electrode constructs. 26 We describe here our modification of this technique, by using real-time guidance of an RNS strip electrode into the position of an in Situ interhemispheric electrode. IONM allowed targeting to both intraoperative interictal epileptic spiking and functional (motor-sensory cortex phase reversal mapping technique) neurophysiology.…”

Section: Discussionmentioning

confidence: 99%

Hybrid Fluoroscopic and Neurophysiological Targeting of Responsive Neurostimulation of the Rolandic Cortex

et al. 2021

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BACKGROUND Precise targeting of cortical surface electrodes to epileptogenic regions defined by anatomic and electrophysiological guideposts remains a surgical challenge during implantation of responsive neurostimulation (RNS) devices. OBJECTIVE To describe a hybrid fluoroscopic and neurophysiological technique for targeting of subdural cortical surface electrodes to anatomic regions with limited direct visualization, such as the interhemispheric fissure. METHODS Intraoperative two-dimensional (2D) fluoroscopy was used to colocalize and align an electrode for permanent device implantation with a temporary in Situ electrode placed for extraoperative seizure mapping. Intraoperative phase reversal mapping technique was performed to distinguish primary somatosensory and motor cortex. RESULTS We applied these techniques to optimize placement of an interhemispheric strip electrode connected to a responsive neurostimulator system for detection and treatment of seizures arising from a large perirolandic cortical malformation. Intraoperative neuromonitoring (IONM) phase reversal technique facilitated neuroanatomic mapping and electrode placement. CONCLUSION In challenging-to-access anatomic regions, fluoroscopy and intraoperative neurophysiology can be employed to augment targeting of neuromodulation electrodes to the site of seizure onset zone or specific neurophysiological biomarkers of clinical interest while minimizing brain retraction.

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Magnetically Guided Neuronavigation of Flexible Instruments in Shunt Placement, Transsphenoidal Procedures, and Craniotomies

Abstract: Tracking of flexible instruments was easily accomplished as the tip of the instrument was followed within the patient's head. There were no major interferences with other metallic instruments within the surgical field.

Cited by 9 publications

References 16 publications

Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study

Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study

Electromagnetic Navigation for Thoracic Aortic Stent-graft Deployment: A Pilot Study in Swine

Hybrid Fluoroscopic and Neurophysiological Targeting of Responsive Neurostimulation of the Rolandic Cortex

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