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1.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(6): 576-580, 2021 Jun 09.
Artículo en Chino | MEDLINE | ID: mdl-34098674

RESUMEN

To explore the technical process and the therapeutic effect of using sequential surgical guide with independent intellectual property rights assisting immediate implantation and restoration of the full arch, with the support from the periodontal splint for mobile supporting teeth, patients with severe periodontitis who planned to undergo immediate full arch implantation were recruited from August 2019 to December 2020 at the Department of Prosthodontics, Department of Periodontology, Department of Implantology and First Clinical Division, Peking University School and Hospital of Stomatology. Through the procedure of collecting preoperative maxillofacial data, making systematic diagnostic design, making periodontal splints fixation, producing surgical guide, and carrying out guided surgery for full arch immediate implantation, eight cases were included. By registering the postoperative cone-beam CT (CBCT) with the preoperative data, the difference between the actual three-dimensional position of the implants and the virtual design was observed, and the accuracy of the implant placement position guided by the sequential guide was statistically analyzed using SPSS 25.0 software. Analysis indicators include coronal and apical global displacement, coronal horizontal and vertical displacement, apical horizontal and vertical displacement, and angular deviation. Results revealed that the 8 patients [2 males and 6 females, aged (49.0±9.3) years (38-65 years)] of recruited cases included 7 cases of maxilla and 1 cases of mandible. A total of 48 implants, of which 44 implants were placed upright and 4 were placed tilted, 16 implants in the anterior region and 32 implants in the posterior region. No guide plate fracture or damage to important anatomical structures were reported. The overall displacement at the coronal point [(0.83±0.48) mm] and the global displacement at the apical point [(1.36±0.57) mm] were within the clinically acceptable safety range, and the horizontal displacement and vertical displacement at the coronal point, horizontal displacement and vertical displacement at the apical point, and the angle deviation of implants axial have no statistic significant difference in the anterior and posterior region (P>0.05). Periodontal splints combined with sequential surgical guides to assist patients with severe periodontitis for immediate full arch implantation and immediate restoration can expand the indications of guide assisted implant surgery. It meets the safety requirements in clinical applications.


Asunto(s)
Implantes Dentales , Periodontitis , Cirugía Asistida por Computador , Diseño Asistido por Computadora , Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea , Femenino , Humanos , Imagenología Tridimensional , Masculino , Periodontitis/cirugía
2.
Sensors (Basel) ; 21(10)2021 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-34065968

RESUMEN

In recent times, the use of electromagnetic tracking for navigation in surgery has quickly become a vital tool in minimally invasive surgery. In many procedures, electromagnetic tracking is used in tandem with X-ray technology to track a variety of tools and instruments. Most commercially available EM tracking systems can cause X-ray artifacts and attenuation due to their construction and the metals that form them. In this work, we provide a novel solution to this problem by creating a new radiolucent electromagnetic navigation system that has minimal impact on -ray imaging systems. This is a continuation of our previous work where we showed the development of the Anser open-source electromagnetic tracking system. Typical electromagnetic tracking systems operate by generating low frequency magnetic fields from coils that are located near the patient. These coils are typically made from copper, steel, and other dense radiopaque materials. In this work, we explore the use of low density aluminum to create these coils and we demonstrate that the effect on X-ray images is significantly reduced as a result of these novel changes in the materials used. The resulting field generator is shown to give at least a 60% reduction in the X-ray attenuation in comparison to our earlier designs. We verify that the system accuracy of approximately 1.5 mm RMS error is maintained with this change in design.


Asunto(s)
Cirugía Asistida por Computador , Fenómenos Electromagnéticos , Humanos , Fantasmas de Imagen , Radiografía , Rayos X
3.
Int J Comput Dent ; 24(2): 165-179, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34085502

RESUMEN

Computer-assisted implant surgery is one of the techniques that has gained much popularity over the past years. The amount of information that can be managed in a virtual environment allows for a faster, safer, and more precise implant placement. In certain cases, an appropriate implant-supported rehabilitation is accompanied by the need for complementary surgical procedures. The present technique report describes a clinical situation in which a bone reduction template and a stackable implant placement guide were digitally designed and 3D printed for a simultaneous ridge ostectomy and computer-assisted implant placement.


Asunto(s)
Implantes Dentales , Cirugía Asistida por Computador , Diseño Asistido por Computadora , Computadores , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Humanos
4.
J Pak Med Assoc ; 71(5): 1508-1510, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34091648

RESUMEN

The use of intra-operative ultrasound remains a largely underutilized option in brain tumour surgeries. The widespread availability of neuronavigation may be the reason why such a useful modality has become less popular even though recent advances in ultrasound technology have greatly improved its utility. The available literature also clearly shows that it offers additional advantages especially when used with neuronavigation. Herein the authors have briefly touched upon the available literature on the role of intraoperative ultrasound in brain tumour surgeries.


Asunto(s)
Neoplasias Encefálicas , Cirugía Asistida por Computador , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/cirugía , Humanos , Neuronavegación , Procedimientos Neuroquirúrgicos , Ultrasonografía
5.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(3): 246-249, 2021 Jun 08.
Artículo en Chino | MEDLINE | ID: mdl-34096229

RESUMEN

In neurosurgery, skull repair caused by surgical approach is one of the important research contents. In this paper, a rapid reconstruction method of the skull defect with optical navigation system is proposed. This method can automatically reconstruct the structure of skull defect with the intraoperative defect edge points and preoperative medical image data. The head model experiment was used to evaluate the effect of the method, the average error of the reconstruction of the defect in the right orbit was 0.424 mm, while the average error of the reconstruction of the defect in the posterior skull base was 0.377 mm. The experimental results show that the structure of the defect is consistent with the actual defect, and the reconstruction accuracy satisfies the clinical requirements in neurosurgery.


Asunto(s)
Cirugía Asistida por Computador , Craneotomía
6.
Shanghai Kou Qiang Yi Xue ; 30(2): 135-139, 2021 Apr.
Artículo en Chino | MEDLINE | ID: mdl-34109350

RESUMEN

PURPOSE: To compare the accuracy of implant placement between modified and traditional immediate implant placement in mandibular molar regions. METHODS: Twenty-four patients were selected for immediate implantation in the molar area including 24 implantation sites. Preoperative cone-beam CT(CBCT) was conducted and then digital software Simplant 18.0 was used to design the ideal three-dimensional position of the implants. In the experimental group, the implant socket was prepared first according to reference of the remaining natural teeth, then the implant was implanted after minimally invasive extraction. Twelve patients in the control group underwent immediate implantation by traditional immediate implant procedures. Minimally invasive extraction, then socket preparation, and final implanting were performed. All patients underwent CBCT after surgery. Implant sites designed prior to surgery and actual implant sites differences between modified and traditional immediate implant placement were measured by Simplant 18.0 and compared with SPSS 17.0 software package. RESULTS: In the experimental group and control group, the measured average deviation were as follows, the angle was (4.492±0.912)° and (7.255±1.307)°, respectively; The horizontal error of the implant shoulder was (0.379±0.083) mm and (1.229±0.270) mm, respectively; The measuring horizontal error of the implant apex was (1.263±0.267) mm and (2.183±0.264) mm, respectively; The calculative horizontal error of the implant apex was (1.324±0.203) mm and (2.709±0.383) mm, respectively; Depth error of the implant apex was (0.663±0.123) mm and (1.533±0.155) mm, respectively, which were significantly lower than those of the control group. CONCLUSIONS: Compared with the traditional method, modified immediate implantation can improve the accuracy of implantation in mandibular molars.


Asunto(s)
Implantes Dentales , Boca Edéntula , Cirugía Asistida por Computador , Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea , Humanos , Diente Molar/diagnóstico por imagen
7.
Shanghai Kou Qiang Yi Xue ; 30(2): 219-224, 2021 Apr.
Artículo en Chino | MEDLINE | ID: mdl-34109367

RESUMEN

PURPOSE: To use three-dimensional reconstruction measurement, preoperative diagnosis, surgical design, surgical simulation, guide plate production, navigation verification and effect evaluation of orthognathic surgery assisted by digital technology, in order to explore more scientific and reasonable programs and procedures of orthognathic surgery. METHODS: Twenty-five patients with congenital dental and maxillofacial deformity were selected as the experimental subjects, craniofacial spiral CT was conducted before surgery and CT data were imported into Mimics 20.0 software to establish a 3D head digital model. The bone landmarks in three-dimensional reconstruction digital model were selected, measured, analyzed and diagnosed, and the design of the surgical plan and the production of the guide plates were performed. Surgical navigation system was used to confirm the maxillary position, verify the bone retention and guide precise bone grinding during operation. Craniofacial spiral CT was conducted 1 week after surgery for postoperative validation of the surgical design protocol. Statistical analysis was performed using SPSS 24.0 software package. RESULTS: All 25 patients were operated according to the digital orthognathic surgery design and procedure.There were no significant differences in X, Y and Z three-dimensional directions in 10 actual landmarks between the postoperative actual head model and the preoperative predictive head model(P>0.05). CONCLUSIONS: Orthognathic surgery assisted by digital technology has the advantages of precision and minimal invasiveness.


Asunto(s)
Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Cirugía Asistida por Computador , Tecnología Digital , Humanos , Imagenología Tridimensional , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Tomografía Computarizada Espiral
8.
Swiss Dent J ; 131(5): 437-441, 2021 05 10.
Artículo en Alemán | MEDLINE | ID: mdl-33952560

RESUMEN

Modern treatment protocols in implant dentistry focus on lower morbidity and patient-centered outcomes, in addition to commonly applied treatment success criteria. Prosthetically-driven digital planning followed by static computer-assisted implant surgery (sCAIS) may minimize the need for bone augmentation by ideally utilizing the residual crest and thereby improve patient satisfaction. A healthy 37-year-old female suffered from agenesis of both second mandibular premolars and presented wide single-tooth gaps on both sides of the mandible with a moderate (left) and pronounced (right) horizontal bone deficiency. 3D implant planning allowed ideal implant positioning in the residual bone volume while respecting critical anatomical structures. This enabled a flapless sCAIS procedure without bone grafting in the left mandible. On the right side, the insufficient bone volume was augmented simultaneously to the sCAIS using GBR. The clinical and radiographic parameters showed a good oral health status in the 1-year postop examination. The final implant position presented a minimal angular and horizontal deviation from the initial planning. The patient was highly satisfied with the two applied methods but preferred the flapless procedure.


Asunto(s)
Implantes Dentales , Cirugía Asistida por Computador , Adulto , Computadores , Implantación Dental Endoósea , Femenino , Humanos , Boca , Flujo de Trabajo
9.
J Clin Neurosci ; 88: 28-33, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33992198

RESUMEN

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: This study was performed to evaluate the accuracy of cervical pedicle screw (CPS) placement with use of a navigated surgical drill (ND) and to compare it with navigated manual probe (MP) at C3-C6. METHODS: 47 consecutive patients (27 males and 20 females, 67.2 [33-91] years) underwent a posterior cervical fixation using CPSs under an intraoperative 3D - - CT based navigation system (total 207 CPSs). For initial probing, ND with 2.2-mm steel burr was used since Apr. 2017 (Group ND; 33 patients, 152 CPSs). MP was used earlier (Group MP; 14 patients, 55 CPSs). There were no other different procedures between the two groups. The accuracy of CPS placement was graded with postoperative CT and compared between the two groups. RESULTS: There were no significant differences in the total perforation rates both in axial and sagittal planes between Groups ND and MP (axial; 7.2% vs. 14.5%, p = 0.25, sagittal; 10.5% vs. 14.5%, p = 0.46). However, the lateral and rostral perforation rates were significantly reduced in Group ND compared to Group MP (lateral: 36.4% vs. 87.5%, p = 0.04; rostral: 6.3% vs. 100%, p = 0.001). CONCLUSION: Although ND did not decrease the total perforation rate significantly, it reduced the incidence of lateral and rostral perforation. ND is likely to make initial probing easier without a forcible manipulation which might cause vertebral rotation.


Asunto(s)
Tornillos Pediculares , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Cirugía Asistida por Computador/instrumentación , Cirugía Asistida por Computador/métodos , Adulto , Anciano , Anciano de 80 o más Años , Vértebras Cervicales/cirugía , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tornillos Pediculares/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Fusión Vertebral/efectos adversos , Tomografía Computarizada por Rayos X
10.
Stud Health Technol Inform ; 281: 23-27, 2021 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-34042698

RESUMEN

The integration of surgical knowledge into virtual planning systems plays a key role in computer-assisted surgery. The knowledge is often implicitly contained in the implemented algorithms. However, a strict separation would be desirable for reasons of maintainability, reusability and readability. Along with the Department of Oral and Maxillofacial Surgery at Heidelberg University Hospital, we are working on the development of a virtual planning system for mandibular reconstruction. In this work we describe a process for the structured acquisition and representation of surgical knowledge for mandibular reconstruction. Based on the acquired knowledge, an RDF(S) ontology was created. The ontology is connected to the virtual planning system via a SPARQL interface. The described process of knowledge acquisition can be transferred to other surgical use cases. Furthermore, the developed ontology is characterised by a reusable and easily expandable data model.


Asunto(s)
Reconstrucción Mandibular , Cirugía Asistida por Computador , Algoritmos , Humanos , Interfaz Usuario-Computador
11.
Int J Mol Sci ; 22(9)2021 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-33946583

RESUMEN

Molecular imaging of pathologic lesions can improve efficient detection of cancer and cardiovascular diseases. A shared pathophysiological feature is angiogenesis, the formation of new blood vessels. Endoglin (CD105) is a coreceptor for ligands of the Transforming Growth Factor-ß (TGF-ß) family and is highly expressed on angiogenic endothelial cells. Therefore, endoglin-based imaging has been explored to visualize lesions of the aforementioned diseases. This systematic review highlights the progress in endoglin-based imaging of cancer, atherosclerosis, myocardial infarction, and aortic aneurysm, focusing on positron emission tomography (PET), single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), near-infrared fluorescence (NIRF) imaging, and ultrasound imaging. PubMed was searched combining the following subjects and their respective synonyms or relevant subterms: "Endoglin", "Imaging/Image-guided surgery". In total, 59 papers were found eligible to be included: 58 reporting about preclinical animal or in vitro models and one ex vivo study in human organs. In addition to exact data extraction of imaging modality type, tumor or cardiovascular disease model, and tracer (class), outcomes were described via a narrative synthesis. Collectively, the data identify endoglin as a suitable target for intraoperative and diagnostic imaging of the neovasculature in tumors, whereas for cardiovascular diseases, the evidence remains scarce but promising.


Asunto(s)
Enfermedades Cardiovasculares/diagnóstico por imagen , Endoglina/análisis , Neoplasias/diagnóstico por imagen , Animales , Enfermedades Cardiovasculares/cirugía , Humanos , Imagen por Resonancia Magnética/métodos , Neoplasias/cirugía , Imagen Óptica/métodos , Tomografía de Emisión de Positrones/métodos , Cirugía Asistida por Computador/métodos , Tomografía Computarizada de Emisión de Fotón Único/métodos , Ultrasonografía/métodos
12.
Otol Neurotol ; 42(5): 702-705, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-33967246

RESUMEN

OBJECTIVE: Minimally invasive, image-guided cochlear implantation (CI) surgery consists of drilling a precise tunnel from the surface of the mastoid cortex through the facial recess to target the scala tympani. In the first set of clinical trials of this technique, heat-induced facial nerve paresis (House-Brackmann II/VI) occurred on a patient on the last day of the initial trial which was scheduled to be halted secondary to a change in the regulatory requirements dictated by the 2012 the Food and Drug Administration Safety and Innovation Act requiring Investigational Device Exemption approval for previously exempted customized medical device testing. To address this adverse event, extensive changes were made to the drilling protocol; additionally, a custom insertion tool was developed. To address the Food and Drug Administration Safety and Innovation Act, an Investigational Device Exemption was submitted and, subsequently approved. Herein is described our first clinical implementation of the modified technique. PATIENT: Seventy-year-old with profound, postlingual sensorineural hearing loss who had previously undergone right CI via traditional approach in 2015. INTERVENTION: Minimally invasive image-guided left CI. MAIN OUTCOME MEASURE: Time of intervention, final location of CI electrode array within cochlea. RESULTS: Surgery took 155 minutes of which the largest components (in descending order) were soft tissue work, closure, and drilling. Full scala tympani insertion with angular insertion depth of 557 degrees of the electrode array was achieved. There were no complications, and the patient had an uneventful recovery and activation. CONCLUSIONS: Minimally invasive, image-guided CI surgery is achievable and reduces the mastoid depression associated with traditional CI surgery. CLINICALTRIALSGOV INFORMATION: Study NCT03101917, Microtable Microstereotactic Frame and Drill Press and Associated Method for Cochlear Implantation. LEVEL OF EVIDENCE: Case Report.


Asunto(s)
Implantación Coclear , Implantes Cocleares , Cirugía Asistida por Computador , Anciano , Cóclea/diagnóstico por imagen , Cóclea/cirugía , Humanos , Apófisis Mastoides/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos
13.
BMC Musculoskelet Disord ; 22(1): 451, 2021 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-34006234

RESUMEN

BACKGROUND: Augmented Reality (AR) is a rapidly emerging technology finding growing acceptance and application in different fields of surgery. Various studies have been performed evaluating the precision and accuracy of AR guided navigation. This study investigates the feasibility of a commercially available AR head mounted device during orthopedic surgery. METHODS: Thirteen orthopedic surgeons from a Swiss university clinic performed 25 orthopedic surgical procedures wearing a holographic AR headset (HoloLens, Microsoft, Redmond, WA, USA) providing complementary three-dimensional, patient specific anatomic information. The surgeon's experience of using the device during surgery was recorded using a standardized 58-item questionnaire grading different aspects on a 100-point scale with anchor statements. RESULTS: Surgeons were generally satisfied with image quality (85 ± 17 points) and accuracy of the virtual objects (84 ± 19 point). Wearing the AR device was rated as fairly comfortable (79 ± 13 points). Functionality of voice commands (68 ± 20 points) and gestures (66 ± 20 points) provided less favorable results. The greatest potential in the use of the AR device was found for surgical correction of deformities (87 ± 15 points). Overall, surgeons were satisfied with the application of this novel technology (78 ± 20 points) and future access to it was demanded (75 ± 22 points). CONCLUSION: AR is a rapidly evolving technology with large potential in different surgical settings, offering the opportunity to provide a compact, low cost alternative requiring a minimum of infrastructure compared to conventional navigation systems. While surgeons where generally satisfied with image quality of the here tested head mounted AR device, some technical and ergonomic shortcomings were pointed out. This study serves as a proof of concept for the use of an AR head mounted device in a real-world sterile setting in orthopedic surgery.


Asunto(s)
Realidad Aumentada , Cirugía Asistida por Computador , Estudios de Factibilidad , Humanos , Quirófanos
14.
Int J Comput Dent ; 24(1): 9-17, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-34006059

RESUMEN

AIM: The transfer of 3D implant position planning to the clinical site is challenging. The aim of this study was to compare in vitro this transfer accuracy by using dynamic real-time navigation or static surgical guides. MATERIALS AND METHODS: Deviations between planned and actual pilot drill positions were calculated (Denacam and NobelGuide; each n = 90), matching pre- and postoperative CBCT images: entry point, angle, tip (each 3D); depth, mesiodistal/bucco-oral entry points, and angles (each 1D). The influence of the maxilla and mandible, implant region (anterior/posterior), and marker position (ipsilateral/contralateral, Denacam only) was investigated (Mann-Whitney U test). RESULTS: No significant differences occurred regarding entry point (3D), mesiodistal/bucco-oral entry points (1D) or mesiodistal angle (1D) (P > 0.05). The angular and tip deviations (3D) were significantly smaller using Denacam (2.16 ± 0.59 degrees, 0.80 ± 0.55 mm; NobelGuide 2.54 ± 1.19 degrees, 1.09 ± 0.56 mm; P = 0.024, P < 0.0001). The deviations in depth and bucco-oral angle (1D) were significantly smaller using NobelGuide (1.05 ± 0.50 mm, 1.02 ± 1.16 degrees; Denacam 1.50 ± 0.64 mm, 1.51 ± 0.82 degrees; P < 0.0001). Significantly smaller deviations occurred within the mandible (Denacam, 5/8 parameters). Region and marker position showed no influence. No distinct influences were found with the use of NobelGuide. CONCLUSION: Denacam might possibly be a promising alternative to static surgical guides.


Asunto(s)
Implantes Dentales , Cirugía Asistida por Computador , Diseño Asistido por Computadora , Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea , Humanos , Imagenología Tridimensional , Maxilar/cirugía
15.
Int J Comput Dent ; 24(1): 19-27, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-34006060

RESUMEN

AIM: To conduct an observational study evaluating the efficacy of a partially guided system for implant surgery. MATERIALS AND METHODS: The study included 48 implant placements in 24 patients. Following virtual implant planning with designated software, a surgical guide was fabricated using a 3D desktop printer. Each surgically placed implant was compared with its planned position in the software. The coronal and apical distance and angular errors of the implants were evaluated. The correlation between the errors and the variables (residual bone height, surgeon, implant placement site, guide support type, implant diameter) was analyzed using multiple regression analysis. RESULTS: The coronal and apical mean distance errors were 1.28 ± 0.85 and 1.8 ± 0.97 mm, respectively. The mean angular error was 3.66 ± 3.37 degrees. The correlation coefficients (coronal: 0.285; apical: 0.308) indicated a significant linear correlation between the anterior and posterior implant placement positions (P < 0.05). CONCLUSION: A partially guided system with in-office guide fabrication using a 3D desktop printer is a useful option for implant placement.


Asunto(s)
Implantes Dentales , Cirugía Asistida por Computador , Diseño Asistido por Computadora , Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea , Humanos , Imagenología Tridimensional , Impresión Tridimensional
16.
Oper Neurosurg (Hagerstown) ; 20(6): 514-520, 2021 05 13.
Artículo en Inglés | MEDLINE | ID: mdl-33982116

RESUMEN

Robotic systems may help efficiently execute complicated tasks that require a high degree of accuracy, and this, in large part, explains why robotics have garnered widespread use in a variety of neurosurgical applications, including intracranial biopsies, spinal instrumentation, and placement of intracranial leads. The use of robotics in neurosurgery confers many benefits, and inherent limitations, to both surgeons and their patients. In this narrative review, we provide a historical overview of robotics and its implementation across various surgical specialties, and discuss the various robotic systems that have been developed specifically for neurosurgical applications. We also discuss the relative advantages of robotic systems compared to traditional surgical techniques, particularly as it pertains to integration of image guidance with the ability of the robotic arm to reliably execute pre-planned tasks. As more neurosurgeons adopt the use of robotics in their practice, we postulate that further technological advancements will become available that will help achieve improved technical capabilities, user experience, and overall patient clinical outcomes.


Asunto(s)
Neurocirugia , Robótica , Cirugía Asistida por Computador , Humanos , Neurocirujanos , Procedimientos Neuroquirúrgicos
17.
Acta Neurochir Suppl ; 131: 267-273, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33839856

RESUMEN

BACKGROUND: Many surgical procedures, such as placement of intracranial drains, are currently being performed blindly, relying on anatomical landmarks. As a result, accuracy results still have room for improvement. Neuronavigation could address this issue, but its application in an urgent setting is often impractical. Augmented reality (AR) provided through a head-worn device has the potential to tackle this problem, but its implementation should meet physicians' needs. METHODS: The Surgical Augmented Reality Assistance (SARA) project aims to develop an AR solution that is suitable for preoperative planning, intraoperative visualisation and navigational support in an everyday clinical setting, using a Microsoft HoloLens. RESULTS: Proprietary hardware and software adaptations and dedicated navigation algorithms are applied to the Microsoft HoloLens to optimise it specifically for neurosurgical navigation. This includes a pipeline with an additional set of advanced, semi-automated algorithms responsible for image processing, hologram-to-patient registration and intraoperative tracking using infrared depth-sensing. A smooth and efficient workflow while maintaining high accuracy is prioritised. The AR solution provides a fully integrated and completely mobile navigation setup. Initial preclinical and clinical validation tests applying the solution to intracranial drain placement are described. CONCLUSION: AR has the potential to vastly increase accuracy of everyday procedures that are frequently performed without image guidance, but could still benefit from navigational support, such as intracranial drain placements. Technical development should go hand in hand with preclinical and clinical validation in order to demonstrate improvements in accuracy and clinical outcomes.


Asunto(s)
Realidad Aumentada , Drenaje , Humanos , Neuronavegación , Procedimientos Neuroquirúrgicos , Cirugía Asistida por Computador
18.
Artículo en Inglés | MEDLINE | ID: mdl-33819327

RESUMEN

This study evaluated the accuracy of implant placement with surgical-template guidance both in vitro and in vivo. Virtual surgical planning was performed based on the data from CBCT scans and an intraoral scanner. Surgical templates were designed according to the planned implants and manufactured with stereolithography. In vitro, 60 implants were placed in 15 resin models. In vivo, 74 implants were placed in 54 patients. The implants were scanned with CBCT postoperatively. Implant accuracy was evaluated by measuring the following parameters: central deviation at the apex and shoulder, horizontal deviation at the apex and shoulder, vertical deviation at the apex and shoulder, and angular deviation. There were statistically significant in vitro and in vivo deviations for all parameters, and the implant deviations in vivo were significantly greater than those in vitro. When using a mucosa-supported template, horizontal deviations at the apex were significantly greater than when a teeth-supported template was used. Within the limitation of the study design, inaccuracy existed in implant placement guided with a surgical template. More studies are needed to investigate the value of the procedure in future.


Asunto(s)
Implantes Dentales , Cirugía Asistida por Computador , Diseño Asistido por Computadora , Tomografía Computarizada de Haz Cónico , Implantación Dental Endoósea , Humanos , Imagenología Tridimensional , Planificación de Atención al Paciente
19.
BMC Surg ; 21(1): 181, 2021 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-33823821

RESUMEN

BACKGROUND: The imaging characteristics of sacral sacralalar-iliac (S2AI) screw trajectory in adult degenerative scoliosis (ADS) patients will be determined. METHODS: S2AI screw trajectories were mapped on three-dimensional computed tomography (3DCT) reconstructions of 40 ADS patients. The starting point, placement plane, screw template, and a circle centered at the lowest point of the ilium inner cortex were set on these images. A tangent line from the starting point to the outer diameter of the circle was selected as the axis of the screw trajectory. The related parameters in different populations were analyzed and compared. RESULTS: The trajectory length of S2AI screws in ADS patients was 12.00 ± 0.99 cm, the lateral angle was 41.24 ± 3.92°, the caudal angle was 27.73 ± 6.45°, the distance from the axis of the screw trajectory to the iliosciatic notch was 1.05 ± 0.81 cm, the distance from the axis of the screw trajectory to the upper edge of the acetabulum was 1.85 ± 0.33 cm, and the iliac width was 2.12 ± 1.65 cm. Compared with females, the lateral angle of male ADS patients was decreased, but the trajectory length was increased (P < 0.05). Compared to patients without ADS in previous studies, the lateral angle of male patients was larger, the lateral angle of female patients was increased, and the caudal angle was decreased (P < 0.05). CONCLUSIONS: There is an ideal trajectory of S2AI screws in ADS patients. A different direction should be noticed in the placement of S2AI screws, especially in female patients.


Asunto(s)
Ilion , Sacro , Escoliosis , Adulto , Tornillos Óseos , Femenino , Humanos , Ilion/diagnóstico por imagen , Ilion/cirugía , Imagenología Tridimensional , Masculino , Sacro/diagnóstico por imagen , Sacro/cirugía , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Cirugía Asistida por Computador , Tomografía Computarizada por Rayos X
20.
Artículo en Inglés | MEDLINE | ID: mdl-33801039

RESUMEN

The aim of this in vitro study was to determine whether the process chain influences the accuracy of a computer-assisted dynamic navigation procedure. Four different data integration workflows using cone-beam computed tomography (CBCT), conventional impressions, and intraoral digitization with and without reference markers were analyzed. Digital implant planning was conducted using data from the CBCT scans and 3D data of the oral models. The restoration of the free end of the lower jaw was simulated. Fifteen models were each implanted with two new teeth for each process chain. The models were then scanned with scan bodies screwed onto the implants. The deviations between the planned and achieved implant positions were determined. The evaluation of all 120 implants resulted in a mean angular deviation of 2.88 ± 2.03°. The mean 3D deviation at the implant shoulder was 1.53 ± 0.70 mm. No significant differences were found between the implant regions. In contrast, the workflow showed significant differences in various parameters. The position of the reference marker affected the accuracy of the implant position. The in vitro examination showed that precise implantation is possible with the dynamic navigation system used in this study. The results are of the same order of magnitude that can be achieved using static navigation methods. Clinical studies are yet to confirm the results of this study.


Asunto(s)
Cirugía Asistida por Computador , Diseño Asistido por Computadora , Computadores , Tomografía Computarizada de Haz Cónico , Flujo de Trabajo
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