Showing papers on "Neuronavigation published in 1997"
TL;DR: This report reports on the first successful intraoperative update of interactive image guidance based on an intraoperatively acquired magnetic resonance imaging (MRI) date set, demonstrating the feasibility of recalibrating navigation with intraoperative MRI.
Abstract: We report on the first successful intraoperative update of interactive image guidance based on an intraoperatively acquired magnetic resonance imaging (MRI) data set. To date, intraoperative imaging methods such as ultrasound, computerized tomography (CT), or MRI have not been successfully used to update interactive navigation. We developed a method of imaging patients intraoperatively with the surgical field exposed in an MRI scanner (Magnetom Open; Siemens Corp., Erlangen, Germany). In 12 patients, intraoperatively acquired 3D data sets were used for successful recalibration of neuronavigation, accounting for any anatomical changes caused by surgical manipulations. The MKM Microscope (Zeiss Corp., Oberkochen, Germany) was used as navigational system. With implantable fiducial markers, an accuracy of 0.84 ± 0.4 mm for intraoperative reregistration was achieved. Residual tumor detected on MRI was consequently resected using navigation with the intraoperative data. No adverse effects were observed from int...
174 citations
TL;DR: This preliminary study of the frameless integration of ultrasonography into stereotactic space demonstrated its clinical usefulness and it is believed that the concept of pre- and intraoperative image-guided surgery presented here will find increasing use in the future.
Abstract: OBJECTIVE: We have developed a frameless stereotactic neuronavigation system that allows navigation during neurosurgical procedures through an image formed from integrating ultrasonography and preoperative magnetic resonance (MR) imaging and/or x-ray computed tomography. METHODS: The system consists of an ultrasound imaging scanner, a workstation with an image capture board, and an ultrasonic tracking sensor with a 5-MHz ultrasonographic transducer. The ultrasonic tracking sensor measures the position and orientation of the ultrasonographic transducer. The oblique plane of the MR/computed tomographic image corresponding to the ultrasound image is then displayed on the workstation monitor. A three-dimensional computer graphic representation of the integrated image is also reported as a preliminary test. For the patient-image registration, the coordinates of digitized and imaged markers on a specially developed reference frame are used. The reference frame is noninvasive because it is not bolted but only fastened to the patient's head with silicon. RESULTS: Based on the findings from the clinical application of the system in three cases, the system was advantageous because the surgical procedures could be controlled by intraoperative ultrasonography as well as by preoperative MR/computed tomographic images. Missing parts in the ultrasonogram were supplemented with preoperative MR/computed tomographic images. At other times, spatial positioning and visualization by ultrasonography were useful for identifying anatomical objects in the image. CONCLUSION: This preliminary study of the frameless integration of ultrasonography into stereotactic space demonstrated its clinical usefulness. We believe that the concept of pre- and intraoperative image-guided surgery presented here will find increasing use in the future.
132 citations
TL;DR: The study revealed that neuronavigation has to be regarded as time neutral in general neurosurgery, whereas in stereotactic surgery, namely biopsy retrival, a significant reduction of anaesthetic time can be achieved through the complete separation of imaging and operation in the frameless approach.
Abstract: It is uncertain whether the use of imaggguided surgery has an influence on operating time. We prospectively studied the time requirements which have to be invested for using image-guided surgery and p
43 citations
TL;DR: The method of frameless stereotactic biopsy retrieval with an infrared-based neuronavigation system is described, clinical results are given, and further areas of application discussed.
Abstract: Interactive image guidance is now in routine use for open neurosurgical procedures and has demonstrated patient benefits. However, freehand interactive guidance is not an appropriate replacement for the traditional frame-based stereotactic procedures of biopsy, electrode placement, and functional lesioning. These point-based procedures require precise target localization and direct instrument guidance to avoid collateral brain injury. To perform true frameless stereotactic procedures requires a guide that is also adjustable for positioning, lockable, and adaptable to multiple instruments. We describe such a device, which is employed for the guidance of biopsy needles, shunts, electrodes, and endoscopes during neuronavigation. The method of frameless stereotactic biopsy retrieval with an infrared-based neuronavigation system is described, clinical results are given, and further areas of application discussed.
29 citations
TL;DR: The present paper summarizes past and current work in the field of computer assisted orthopaedic surgery and describes the state of the art of research and future innovations, particularly in in vivo applications.
Abstract: Computer assisted orthopaedic surgery is a new but rapidly evolving field. Based on previous research and development in the area of stereotactic neuronavigation a few groups have adapted these technologies for the image interactive insertion of pedicle screws. The present paper summarizes past and current work in the field of computer assisted orthopaedic surgery and describes the state of the art of research and future innovations, particularly in in vivo applications.
27 citations
TL;DR: Tailored selective amygdalohippocampal resections seem to be an interesting application for neuronavigation, but the hippocampal resection length was overestimated by navigation to an extent of 3 +/- 2 mm.
Abstract: Tailored selective amygdalohippocampal resections seem to be an interesting application for neuronavigation. The accuracy of freehand frameless neuronavigation was assessed in 28 patients for its abil
23 citations
20 citations
TL;DR: The management of this lesion, which is rare in childhood, demonstrates the potential of combining frameless stereotaxy for precise target approach with conventional open microneurosurgery to minimize morbidity.
Abstract: Excision of a ruptured aneurysm located at a lenticulostriate feeding artery associated with an arteriovenous malformation was performed using image guided neuronavigation in an 8-year-old child. The management of this lesion, which is rare in childhood, demonstrates the potential of combining frameless stereotaxy for precise target approach with conventional open microneuro-surgery to minimize morbidity-Because of the unavoidable shifting of the brain that occurs during surgery, a catheter pointing towards the dome of the aneurysm was placed using image guidance prior to insertion of spatulae.
18 citations
Journal Article•
TL;DR: Surgical procedures using the neuronavigation system were anterior temporal lobectomy, corpus callosotomy and lesionectomy of focal cortical dysplasia, and the Viewing Wand system was accurate, reliable and easy to operate in these procedures.
Abstract: Availability of a neuronavigation system for epilepsy surgery was reported, and its practical use was discussed. Four of nine patients with intractable epilepsy underwent surgical procedures using a neuronavigation system, Viewing wand, from November 1995 to August 1996, in our hospital. The ages of patients were between 9 to 46 years old. Three of them had temporal lobe epilepsy and one had generalized tonic seizures. One of the temporal lobe epilepsy cases had focal cortical dysplasia in the left posterior temporal lobe, and the other one showed that left hippocampal atrophy on MR images. The remaining two patient had no abnormality on MR images. All patients underwent video-EEG monitoring and habitual seizures were recorded at least three times. Ictal and/or interictal SPECT and neuropsychological testing were also performed. Electrocorticograms were recorded intraoperatively in all patients. Surgical procedures using the neuronavigation system were anterior temporal lobectomy, corpus callosotomy and lesionectomy of focal cortical dysplasia. A patient with temporal lobe epilepsy underwent implantation of depth electrodes under the neuronavigation. In temporal lobectomy, image-guided surgery helped to make a decision concerning the safely-resectable size of the lateral temporal cortex and hippocampus. The hippocampus was resected with minimum surgical damage and it made possible a complete histopathological examination. In corpus callosotomy, although it was not easy to confirm the length of the callosal section, the neuronavigation system enabled this to be done quickly. The real-time navigation showed the accurate operating position on three-dimensional images. The location of focal cortical dysplasia was often difficult to identify macroscopically. However, the location of the lesion can be projected to the skin surface under the neuronavigation system. The width of skin incision and craniotomy was able to be made smaller, and the surgery was able to be performed less invasively. The Viewing Wand system was accurate, reliable and easy to operate in these procedures. The navigating error was 2-5 mm. Using CT image data of 5 mm thickness the error was greater, although use of MR image data of 2 mm thickness resulted in relatively small error up to 2-3 mm. The first major factor of the error was the fiducial registration of the patient's head. While the registration was made more strictly with multiple fiducial points, the error was smaller. The second factor was movement of patient's head and/or the navigation arm. The arm and the head should be fixed tightly to the operating table, and it is better if they are fixed together with a supporting arm. The third factor was intraoperative brain shift caused by flow out of the cerebrospinal fluid or removal of mass lesions. This type of error is common in all navigation systems. However, it may be avoided making some real-time feedback system. With the Viewing Wand system, repetition of the intraoperative registration using intracranial anatomical structures reduces this type of error. On the other hand, there were some difficulties on stereotaxic procedures, such as implantation of depth electrodes, using the Viewing Wand. The error was larger than that recorded in other frame-based stereotaxic apparatus. This problem may be improved by a supporting system to fix the probe position. As a neuronavigation system can be widely applied to neurosurgical procedures, we consider that epilepsy and skull-base surgery are the best targets for it because of the minimum possible brain shift. We hope that accurate and less-invasive surgery using a neuronavigation system will contribute to a better outcome for epilepsy patients.
15 citations
TL;DR: It is concluded that neuronavigation (combined with motor cortex stimulation) may decrease neurological injury or neurosurgical invasiveness in lesions of the central region.
Abstract: An infrared-based neuronavigation device (Surgical Microscope Navigator) integrating a pointer system with microscope guidance, is presented. We report our experience with this system in 17 patients undergoing surgery for space-occupying lesions of the central region. Cortical motor stimulation was additionally used in selected cases. The system was helpful in all operations by guiding craniotomy, corticotomy, or extent of tissue resection. Gross total tumor removal was possible in all patients but 1. Technical problems occurred in 1 case. Postoperative neurological worsening was found in 3 patients; this was reversible within a few weeks in 2 of them. In 9 cases, neuronavigation (combined with cortical stimulation, if necessary) probably prevented permanent neurological injury by exactly localizing tumors in the central area. It is concluded that neuronavigation (combined with motor cortex stimulation) may decrease neurological injury or neurosurgical invasiveness in lesions of the central region.
15 citations
TL;DR: The planning and performance of neurosurgical procedures in the past have been based solely on the surgeon’s experience and interpretation of 2D imaging studies (CT, MRI).
Abstract: The planning and performance of neurosurgical procedures in the past have been based solely on the surgeon’s experience and interpretation of 2D imaging studies (CT, MRI). Stereotactic guidance and in
01 Jan 1997
TL;DR: The causes of intraoperative brain shift, decompressive effects by craniotomy, dural opening, and suction of cerebrospinal fluid, and changes of brain volume by administration of anesthetic and osmotic agents and intraoperative management of respiration and blood pressure are analyzed.
Abstract: Brain shift during open neurosurgery is a major factor causing errors in intraoperative neuronavigation based on preoperative neuroradiological images. Under the observation of intraoperative CT images provided by the operating CT scanner system in Shinshu University Hospital, the causes of intraoperative brain shift were analyzed. As direct surgical factors of intraoperative brain shift, decompressive effects by craniotomy, dural opening, and suction of cerebrospinal fluid may play a significant role on intraoperative shift. Also, surgical procedures including brain retraction and dissection significantly affect intraoperative CT findings. Furthermore, changes of brain volume by administration of anesthetic and osmotic agents and intraoperative management of respiration and blood pressure may be important indirect factors in intraoperative brain shift affecting neuronavigation.
TL;DR: It is the experience that this neuronavigation system improves approach planning and facilitates decisions as to resection borders with low and high grade gliomas as well as metastases.
Abstract: Summary. Computer-assisted intraoperative image information from CT/MR image data, in short computer-assisted surgery (CAS), is increasingly used in various fields of surgery to optimally analyse the intraoperative site. In neurosurgery, the employment of the new frameless navigation system has today with some indications already replaced frame-guided stereotactic methods of localization. With the MKM system (Zeiss, Germany), the operating microscope itself has been converted into a navigation device through robot-control and optical data superimposition. This paper reports the results we obtained in using this system for the localization of intracranial tumours in 29 patients. It is our experience that this neuronavigation system improves approach planning and facilitates decisions as to resection borders with low and high grade gliomas as well as metastases.
Journal Article•
01 Jan 1997
TL;DR: A new type of endoscopic surgery, computer-assisted endomicroscopic surgery, consisting of a lenscope, a neuronavigation system, and a mechanical holding system, which is believed to provide one means of minimally invasive neurosurgery.
Abstract: Conventional neuroendoscopic surgery using a stereotaxic frame has two important problems: difficulty of holding the lenscope and loss of orientation. To solve these problems, we developed a new type of endoscopic surgery, computer-assisted endomicroscopic surgery. Computer-assisted endomicroscopic surgery was performed using the “navigated endomicroscope,” consisting of a lenscope, a neuronavigation system, and a mechanical holding system. A three-dimensional (3-D) video system is also available. The motion of the system is smooth, and the endoscope can easily be set at any position and to any direction and also held very firmly. The position of the endoscope in the brain was continuously monitored throughout the operations. This configuration resembles a small system of a microscope equipped with neuronavigation. We believe the endomicroscope provides one means of minimally invasive neurosurgery.
TL;DR: Familiarity, ease of access, trust, and awareness of risks and benefits are all important.
Abstract: 頸動脈疾患におけるドプラ超音波を用いた無症候性の塞栓シグナル (ES) の検出の頻度は高く, 疾患の活動性のマーカーとなり, 卒中リスクの高い患者の選択を可能にする.しかし報告によって無症候性ESの検出頻度が異なっており, ESの同定に違ったクライテリアが用いられているのではないかという懸念がある.前回の二つのセンターの間の再現性調査では良好な一致を見たが多数のセンター問の調査は行われていない.ES検出について最近報告を出している九つのセンターの間で国際的な再現性調査が行われた.各センターは症候性頸動脈狭搾のある六人の患者の中大脳動脈TCD記録のオーデイオドプラ信号をブラインドで解析した.ESを検出した正確な時間を記録した.六つのセンターでは各ESの強度の増加も記録した.観察者間の一致は特別な協定に基づく方法で決められた.七つのセンターは39-55の信号を記録した.しかし一つのセンターは142のESを報告した.観察者間の一致確率は.678であるが, 最多のESを報告したセンターを除くと.791であった.デシベル閾値を導入すると一致確率は著明に上昇した.>7dBのデシベル閾値にすると.902の一致確率となった.大概のセンター問での強度測定は良い相関を示したが必ずしも常にそうではない.15の相関のうち3は有意ではなかった.測定された強度の絶対値はセンター間で40%も違っていた.結論: 研究報告によってESの頻度が違うのは少なくともある程度はESの同定に異なるクライテリアが用いられていることを反映している.以前に提唱されていたES同定のコンセンサスクライテリアは異なるセンターにおけるES同定の再現性には十分に精確とはいえない.デシベル閾値を用いると再現性が向上し観察者間の一致率の著明な改善が得られる.しかし, 一つのセンターで開発された強度閾値をそのまま他の施設で使うことは出来ない.測定方法が違うので同じ装置が用いられていても同じESで違った強度の値が得られるのである.
01 Jan 1997
TL;DR: From the experience with this system, it is concluded that the infrared-based neuro-navigator is a very useful technology that increases accuracy and the safety of surgical resection.
Abstract: The surgical management of intracranial tumors has always been a challenge for the neurosurgeon, from the dual perspective of acquiring a complete resection on one hand and maintaining neurological function on the other. Stereotactic technology followed by computer-assisted neuronavigation has markedly changed the outcome of these operations. It has improved the accuracy of resection, diminished the neurological complication rate, and decreased the length of hospital stay and costs. Interactive image-guided surgery has extended its applications to other fields such as epilepsy and skull-base and spine surgery, and is even used in brain trauma. From December 1991 to December 1996, we used an infrared-based system for intraoperative image-guided resections; in 1995 we began using the same system for spinal applications as well. Our patient group includes 464 patients treated for intracranial pathology and 27 for spinal lesions. In this chapter we discuss our system, protocols used for different applications, and preliminary results in patient care. From our experience with this system we conclude that the infrared-based neuro-navigator is a very useful technology that increases accuracy and the safety of surgical resection.
TL;DR: Stereotaxy evolution is based on new equipments which allow neurosurgeons and radiotherapeuts to work without frame to hit very precisely an intra cerebral target in an exploratory or a therapeutic aim with a very low rate of complications.
Abstract: Stereotaxy is a minimal invasive surgery which permits to hit very precisely an intra cerebral target in an exploratory or a therapeutic aim with a very low rate of complications. This technique is used in the field of neurosurgery and radiotherapy. Stereotaxy evolution is based on new equipments which allow neurosurgeons and radiotherapeuts to work without frame. Digitized surgery systems are currently used in neurosurgery. Stereotaxy is also a multidisciplinary technique regrouping neurosurgeons, neuroradiologists and radiotherapeuts.
01 Jan 1997
TL;DR: The management of a ruptured aneurysm located at a lenticulostriate feeding artery associated with an arteriovenous malformation was performed using image guided neuronavigation in an 8- year-old child, demonstrating the potential of combining frame imaging stereotaxy for precise target approach with conventional open microneuro- surgery to minimize morbidity.
Abstract: Excision of a ruptured aneurysm located at a lenticulostriate feeding artery associated with an arteriovenous malformation was performed using image guided neuronavigation in an 8- year-old child. The management of this lesion, which is rare in childhood, demonstrates the potential of combining frameIess stereotaxy for precise target approach with conventional open microneuro- surgery to minimize morbidity. Because of the unavoidable shifting ofthe brain that occurs during surgery, a catheter pointing towards the dome of the aneurysm was placed using image guidance prior to insertion of spatulae. Comp Aid Szcq 2:5-10 (1997). 01997 Wiley-Liss, Inc. ~
01 Jan 1997
TL;DR: The computer-aided neuronavigation system appears to require a feedback technique for intraoperative brain shift that would enhance precision, reliability, and safety in this respect, and CT-fluoroscopy combined with intraoperative CT is considered to play a potentially very important role.
Abstract: An innovative imaging procedure, computed tomographic (CT) fluoroscopy, was recently developed by Katada and Toshiba Medical Corporation in Japan [1,2]. This procedure permits sequential display of computed tomograms in real time. CT-fluoroscopy has been found to be extremely useful for real-time monitoring, which ensures the safety and accuracy of invasive techniques such as punctures in the neurosurgical field [3]. We recently, attempted targeted needle biopsy at three points, the subcortex near the lesion and the lateral side and center of the lesion, under CT-fluoroscopy. We then attempted to precisely place a marker at the inner border of the lesion near the internal capsule. A round mini-coil was used as the marker. Two weeks later we succeeded in extensively resecting the tumor lesion without producing motor weakness because the marker’s shadow on an ultrasonic image allowed navigation to the bottom of the lesion very precisely by showing where the eloquent area was located. A neuronavigation system using preoperative images was used simultaneously. There was a difference of 10 mm between the point indicated with the navigator and the actual position of the marker. This difference is considered to reflect brain shift caused by intraoperative leakage of cerebrospinal fluid. Thus, the computer-aided neuronavigation system appears to require a feedback technique for intraoperative brain shift that would enhance precision, reliability, and safety. In this respect, CT-fluoroscopy combined with intraoperative CT is considered to play a potentially very important role.