Total knee arthroplasties from the origin to navigation: history, rationale, indications.

Since the early 1970s, total knee arthroplasties have undergone many changes in both their design and their surgical instrumentation. It soon became apparent that to improve prosthesis durability, it was essential to have instruments which allowed them to be fitted reliably and consistently. Despite increasingly sophisticated surgical techniques, preoperative objectives were only met in 75% of cases, which led to the development, in the early 1990s, in Grenoble (France), of computer-assisted orthopaedic surgery for knee prosthesis implantation. In the early 2000s, many navigation systems emerged, some including pre-operative imagery ("CT-based"), others using intra-operative imagery ("fluoroscopy-based"), and yet others with no imagery at all ("imageless"), which soon became the navigation "gold standard". They use an optoelectronic tracker, markers which are fixed solidly to the bones and instruments, and a navigation workstation (computer), with a control system (e.g. pedal). Despite numerous studies demonstrating the benefit of computer navigation in meeting preoperative objectives, such systems have not yet achieved the success they warrant, for various reasons we will be covering in this article. If the latest navigation systems prove to be as effective as the older systems, they should give this type of technology a well-deserved boost.

Focused ultrasound in neurosurgery: a historical perspective.

Focused ultrasound (FUS) has been under investigation for neurosurgical applications since the 1940s. Early experiments demonstrated ultrasound as an effective tool for the creation of intracranial lesions; however, they were limited by the need for craniotomy to avoid trajectory damage and wave distortion by the skull, and they also lacked effective techniques for monitoring. Since then, the development and hemispheric distribution of phased arrays has resolved the issue of the skull and allowed for a completely transcranial procedure. Similarly, advances in MR technology have allowed for the real-time guidance of FUS procedures using MR thermometry. MR-guided FUS (MRgFUS) has primarily been investigated for its thermal lesioning capabilities and was recently approved for use in essential tremor. In this capacity, the use of MRgFUS is being investigated for other ablative indications in functional neurosurgery and neurooncology. Other applications of MRgFUS that are under active investigation include opening of the blood-brain barrier to facilitate delivery of therapeutic agents, neuromodulation, and thrombolysis. These recent advances suggest a promising future for MRgFUS as a viable and noninvasive neurosurgical tool, with strong potential for yet-unrealized applications.

Advancements in Maxillofacial Trauma: A Historical Perspective.

For the 75th anniversary of the Journal of Oral and Maxillofacial Surgery, the authors were asked to review the past and examine advancements in the management of facial trauma. Several important advances in the management of maxillofacial trauma have resulted in improved outcomes. These include the development of high-resolution computed tomography, improved classification schemes, rigid fixation techniques, improved biomaterials, soft tissue resuspension, and primary bone grafting. Further advances in outcomes have occurred with the use of microsurgical techniques, free tissue transfer techniques, virtual surgical planning, endoscopic techniques, and surgical navigation. Historic treatments and these important advances are discussed.

Image-Guided Interventions: We've come a long way, but are we there?

While the term "image-guided surgery" has gained popularity fairly recently, the use of imaging for medical interventions dates as far back as the beginning of the 20th century. Dr. George H. Gray of Lynn, Massachusetts, reported in his 1908 article "X-rays in Surgical Work," published in volume 2 of the Journal of Therapeutics and Dietetics, that "the one great stride in the handling of difficult cases was the accurate diagnosis made possible by the use of the X-rays." His story points to the day when a seamstress presented to his office with a broken sewing needle embedded in her hand. Thanks to the use of the recently discovered X-rays by Wilhelm Conrad Roentgen, the father of diagnostic radiology, Gray was able not only to confirm that the needle was indeed embedded in her hand but also to locate its parts, saving "an hour's hunting as some had previously done and then often failed."

Current use of navigation system in ACL surgery: a historical review.

PURPOSE: The present review aims to analyse the available literature regarding the use of navigation systems in ACL reconstructive surgery underling the evolution during the years. METHODS: A research of indexed scientific papers was performed on PubMed and Cochrane Library database. The research was performed in December 2015 with no publication year restriction. Only English-written papers and related to the terms ACL, NAVIGATION, CAOS and CAS were considered. Two reviewers independently selected only those manuscripts that presented at least the application of navigation system for ACL reconstructive surgery. RESULTS: One hundred and forty-six of 394 articles were finally selected. In this analysis, it was possible to review the main uses of navigation system in ACL surgery including tunnel positioning for primary and revision surgery and kinematic assessment of knee laxity before and after different surgical procedures. In the early years, until 2006, navigation system was mainly used to improve tunnel positioning, but since the last decade, this tool has been principally used for kinematics evaluation. Increased accuracy of tunnel placement was observed using navigation surgery, especially, regarding femoral, 42 of 146 articles used navigation to guide tunnel positioning. During the following years, 82 of 146 articles have used navigation system to evaluate intraoperative knee kinematic. In particular, the importance of controlling rotatory laxity to achieve better surgical outcomes has been underlined. CONLUSIONS: Several applications have been described and despite the contribution of navigation systems, its potential uses and theoretical advantages, there are still controversies about its clinical benefit. The present papers summarize the most relevant studies that have used navigation system in ACL reconstruction. In particular, the analysis identified four main applications of the navigation systems during ACL reconstructive surgery have been identified: (1) technical assistance for tunnel placement; (2) improvement in knowledge of the kinematic behaviour of ACL and other structures; (3) comparison of effectiveness of different surgical techniques in controlling laxities; (4) navigation system performance to improve the outcomes of ACL reconstruction and cost-effectiveness. LEVEL OF EVIDENCE: IV.

[Georg Schlöndorff-the father of computer-assisted surgery]. / Georg Schlöndorff - Vater der "computerassistierten Chirurgie".

Georg Schlöndorff (1931-2011) developed the idea of computer-assisted surgery (CAS) during his time as professor and chairman of the Department of Otorhinolaryngology at the Medical Faculty of the University of Aachen, Germany. In close cooperation with engineers and physicists, he succeeded in translating this concept into a functional prototype that was applied in live surgery in the operating theatre. The first intervention performed with this image-guided navigation system was a skull base surgical procedure 1987. During the following years, this concept was extended to orbital surgery, neurosurgery, mid-facial traumatology, and brachytherapy of solid tumors in the head and neck region. Further technical developments of this first prototype included touchless optical positioning and the computer vision concept with three orthogonal images, which is still common in contemporary navigation systems. During his time as emeritus professor from 1996, Georg Schlöndorff further pursued his concept of CAS by developing technical innovations such as computational fluid dynamics (CFD).

The start and development of epilepsy surgery in Europe: a historical review.

Epilepsy has not always been considered a brain disease, but was believed to be a demonic possession in the past. Therefore, trepanation was done not only for medical but also for religious or spiritual reasons, originating in the Neolithic period (3000 BC). The earliest documentation of trepanation for epilepsy is found in the writings of the Hippocratic Corpus and consisted mainly of just skull surgery. The transition from skull surgery to brain surgery took place in the middle of the nineteenth century when the insight of epilepsy as a cortical disorder of the brain emerged. This led to the start of modern epilepsy surgery. The pioneer countries in which epilepsy surgery was performed in Europe were the UK, Germany, and The Netherlands. Neurosurgical forerunners like Sir Victor Horsley, William Macewen, Fedor Krause, and Otfrid Foerster started with "modern" epilepsy surgery. Initially, epilepsy surgery was mainly done with the purpose to resect traumatic lesions or large surface tumours. In the course of the twentieth century, this changed to highly specialized microscopic navigation-guided surgery to resect lesional and non-lesional epileptogenic cortex. The development of epilepsy surgery in Southern Europe, which has not been described until now, will be elaborated in this manuscript. To summarize, in this paper, we provide (1) a detailed description of the evolution of European epilepsy surgery with special emphasis on the pioneer countries; (2) novel, never published information about the development of epilepsy surgery in Southern Europe; and (3) we review the historical dichotomy of invasive electrode implantation strategy (Anglo-Saxon surface electrodes versus French-Italian stereoencephalography (SEEG) model).

The role of imaging in the development of neurosurgery.

The development of modern neurosurgery was, and remains, intimately associated with developments in radiology. Neuroimaging advances have been instrumental in improving patient care and reducing both morbidity and mortality for neurosurgical patients. The purpose of this narrative review is to provide the contemporary neurosurgeon with an overview of the history of the development of radiology as applied to neurosurgery. The focus is on cranial imaging but the spine is also discussed. This article demonstrates the remarkable advancements that have shaped our modern surgical specialty. Today, almost 120 years after the discovery of the X-ray, the neurosurgeon has a wide array of neuroimaging tools at their disposal, that have led to better knowledge to inform diagnosis and management, selection of appropriate patients and surgical targets, as well as optimal surgical approaches. Modern neurosurgery is based on the appropriate use of these investigations. The pace of neuroimaging and neurosurgical advances continues and the future promises to be as, if not more, exciting as the past and present described in this paper.

Thermal ablation of tumours: biological mechanisms and advances in therapy.

Minimally invasive thermal ablation of tumours has become common since the advent of modern imaging. From the ablation of small, unresectable tumours to experimental therapies, percutaneous radiofrequency ablation, microwave ablation, cryoablation and irreversible electroporation have an increasing role in the treatment of solid neoplasms. This Opinion article examines the mechanisms of tumour cell death that are induced by the most common thermoablative techniques and discusses the rapidly developing areas of research in the field, including combinatorial ablation and immunotherapy, synergy with conventional chemotherapy and radiation, and the development of a new ablation modality in irreversible electroporation.

Computers and neurosurgery.

At the turn of the twentieth century, the only computational device used in neurosurgical procedures was the brain of the surgeon. Today, most neurosurgical procedures rely at least in part on the use of a computer to help perform surgeries accurately and safely. The techniques that revolutionized neurosurgery were mostly developed after the 1950s. Just before that era, the transistor was invented in the late 1940s, and the integrated circuit was invented in the late 1950s. During this time, the first automated, programmable computational machines were introduced. The rapid progress in the field of neurosurgery not only occurred hand in hand with the development of modern computers, but one also can state that modern neurosurgery would not exist without computers. The focus of this article is the impact modern computers have had on the practice of neurosurgery. Neuroimaging, neuronavigation, and neuromodulation are examples of tools in the armamentarium of the modern neurosurgeon that owe each step in their evolution to progress made in computer technology. Advances in computer technology central to innovations in these fields are highlighted, with particular attention to neuroimaging. Developments over the last 10 years in areas of sensors and robotics that promise to transform the practice of neurosurgery further are discussed. Potential impacts of advances in computers related to neurosurgery in developing countries and underserved regions are also discussed. As this article illustrates, the computer, with its underlying and related technologies, is central to advances in neurosurgery over the last half century.

[Development of intraoperative C-arm imaging in trauma surgery]. / Entwicklung der intraoperativen C-Bogenanwendung in der Unfallchirurgie.

Since the earliest beginnings of using X-rays, two forms of examination techniques have been known: X-ray imaging and projection onto films. The new technology very rapidly became widespread. Just a few months after the discovery of the so-called X-rays, the first fluoroscopes (instruments for visualizing internal structures) were constructed and constantly improved upon. If the operation took place in bright light, a cryptoscope was needed for examination. Since 1984 fluoroscopic examinations or interventions performed under X-ray control are only permitted when systems are used that are equipped with an image intensifier video chain or a digital image receiver with TV monitor.At about the beginning of the new century the first digital imaging systems with solid-state detectors were put into service. Flat panel detectors offer high-quality imaging with good spatial resolution and contrast recognition. At the present time, storable intraoperative three-dimensional diagnostic imaging is available.