RESUMO
PURPOSE: Automatic methods for preoperative trajectory planning of electrodes in deep brain stimulation are usually based on the search for a path that resolves a set of surgical constraints to propose an optimal trajectory. The relative importance of each surgical constraint is usually defined as weighting parameters that are empirically set beforehand. The objective of this paper is to analyze the use of these parameters thanks to a retrospective study of trajectories manually planned by neurosurgeons. For that purpose, we firstly retrieved weighting factors allowing to match neurosurgeons manually planned choice of trajectory on each retrospective case; secondly, we compared the results from two different hospitals to evaluate their similarity; and thirdly, we compared the trends to the weighting factors empirically set in most current approaches. METHODS: To retrieve the weighting factors best matching the neurosurgeons manual plannings, we proposed two approaches: one based on a stochastic sampling of the parameters and the other on an exhaustive search. In each case, we obtained a sample of combinations of weighting parameters with a measure of their quality, i.e., the similarity between the automatic trajectory they lead to and the one manually planned by the surgeon as a reference. Visual and statistical analyses were performed on the number of occurrences and on the rank means. RESULTS: We performed our study on 56 retrospective cases from two different hospitals. We could observe a trend of the occurrence of each weight on the number of occurrences. We also proved that each weight had a significant influence on the ranking. Additionally, we observed no influence of the medical center parameters, suggesting that the trends were comparable in both hospitals. Finally, the obtained trends were confronted to the usual weights chosen by the community, showing some common points but also some discrepancies. CONCLUSION: The results tend to show a predominance of the choice of a trajectory close to a standard direction. Secondly, the avoidance of the vessels or sulci seems to be sought in the surroundings of the standard position. The avoidance of the ventricles seems to be less predominant, but this could be due to the already reasonable distance between the standard direction and the ventricles. The similarity of results between two medical centers tends to show that it is not an exceptional practice. These results suggest that manual planning software may introduce a bias in the planning by proposing a standard position.
Assuntos
Encefalopatias/cirurgia , Estimulação Encefálica Profunda/métodos , Eletrodos Implantados , Cirurgia Assistida por Computador/métodos , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética , Neuronavegação/métodos , Período Pré-Operatório , Estudos Retrospectivos , SoftwareRESUMO
Presentamos el caso clínico de paciente masculino, quien presenta desde la infancia crisis de disnea, pero es en edad adulta en que su cuadro se vuelve más florido, sin presentar cianosis, viene a esta casa asistencial donde se le diagnostica Tetralogía de Fallot. Lo importante de la descripción de este caso, es que este tipo de patología pertenece al grupo de las cardiopatías congénitas cianosantes, pero hay un reducido número de pacientes que no presentan cianosis y son llamados Fallot rosados, como el que describimos a continuación.
Assuntos
Masculino , Adulto , Cardiopatias Congênitas , Tetralogia de FallotRESUMO
La comunicación intraauricular es la patología congénita más frecuente que se detecta en la edad adulta, siendo más observable en las mujeres, ocupando el tercer lugar entre todas las cardiopatías congénitas precedida por la comunicación interventricular y el ductus. El presente trabajo se trata de una paciente portadora de comunicación interauricular que se diagnostica durante su cuarto embarazo, debido a la sintomatología presentada y la evolución que tuvo hasta la resolución de su embarazo y de su alteración cardiológica...