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1.
J Clin Neurosci ; 85: 41-48, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33581788

RESUMO

To investigate the safety, accuracy and indications of traditional and novel cortical bone screws placement for osteoporosis lumbar spine, 4 lumbar vertebra specimens (2 males and 2 females) were used for this study. After the computed tomography scanning data of the above anatomical specimens were three-dimensional (3D) reconstructed, one side of each anatomical specimen was randomly chosen to place traditional cortical bone screws, and the other side received novel technical placement. The safety screw trajectory was designed, and a 3D navigation template complementary to the surface anatomical structure of lumbar isthmus lateral margin-vertebral plate-spinous process part was established. The designed supporting navigation template was substantialized, and the navigation template replicated different cortical bone screw trajectory at different sides of the same one lumbar vertebra. Forty cortical bone screws were firstly placed in 3D printed vertebra and then 40 were placed in real anatomical specimens. In 3D printed specimens, the success rates of screw placement with navigation template using traditional and novel techniques were both 100%. While in anatomical specimens, the success rate of screw placement using traditional and novel navigation template was 97.5% (one out of 40 went wrong). Therefore, it is safe, accurate and reliable to place traditional and novel cortical bone screws on osteoporosis lumbar spine using 3D printed navigation template. Traditional and novel screw placement methods should be flexibly applied or combined according to specific sequence and form of vertebra.


Assuntos
Imageamento Tridimensional/métodos , Neuronavegação/métodos , Osteoporose/cirurgia , Impressão Tridimensional , Fusão Vertebral/métodos , Idoso , Cadáver , Osso Cortical/cirurgia , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Tomografia Computadorizada por Raios X/métodos
2.
J Clin Neurosci ; 85: 64-66, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33581792

RESUMO

The surgical management of sacro-iliac chondrosarcomas is challenging given their intimate relationship to the nerves and vessels of the pelvis. Osteotomies for en bloc excision can be challenging because of lack of visualization and high risk of injury to pelvic structures. The use of three-dimensional (3D) printed models helps conceptualize the tumor relative to the patient's anatomy. Coupled with stereotactic navigation, safe osteotomy planning and execution can be performed with avoidance of vital nerves and vessels. Very few cases have been reported demonstrating the successful use of these 2 modern technologies for en bloc excision of difficult tumors. We present our technique of using a 3D printed model and navigation for en bloc excision of a large sacro-iliac chondrosarcoma, supplemented with an intraoperative video.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Imageamento Tridimensional/métodos , Neuronavegação/métodos , Osteotomia/métodos , Impressão Tridimensional , Humanos , Lasers , Masculino , Pessoa de Meia-Idade , Articulação Sacroilíaca/patologia , Articulação Sacroilíaca/cirurgia , Resultado do Tratamento
3.
BMC Surg ; 21(1): 58, 2021 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-33485359

RESUMO

BACKGROUND: Endoscopic endonasal transsphenoidal approaches are broadly used nowadays for a vast spectrum of pathologies sited in the anterior and middle cranial fossa. The usage of neuronavigation systems (neuronavigation) in these surgeries is crucial for improving orientations deeply inside the skull and increasing patient safety. METHODS: The aim of this study was to assess the use of optical neuronavigation, together with an intraoperative O-arm O2 imaging system, in a group of patients with hypophyseal adenoma that underwent a transnasal transsphenoidal surgery, and correlate the accuracy and its deviation during the navigational process against the use of conventional neuronavigation that uses preoperative MRI and CT scans. The overall group consisted of six patients, between 39 and 78 years old, with a diagnosis of hypophyseal adenoma. Patients were treated with an endoscopic transsphenoidal technique and all of them underwent preoperative MRI and CT scans of the brain. These images were used in the neuronavigation system StealthStation S7® during the surgery, where we defined two bony anatomical landmarks, such as a vomer or the origin of an intrasphenoidal septum, in each operated patient. The tip of the navigational instrument, under endoscopic control, pointed to these landmarks and the distance between the tip and the bony structure was measured on the neuronavigation system. Afterwards, intraoperative 3D x-ray imaging was performed via the mobile system O-arm O2® system with automatic transfer into the navigational system. Under endoscopic guidance, we localized the identical bony anatomical landmarks used in the previous measurement and re-measured the distance between the tip and bony landmark in images acquired by the O-arm. The results of both measurements were statistically compared. RESULTS: The mean error of accuracy during conventional neuronavigation with usage of preoperative CT and MRI scans was 2.65 mm. During the neuronavigation, with utilization of intraoperative 3D O-arm images, the mean error of accuracy 0 mm. These mean errors of accuracy (both measurement methods were compared by nonparametric Wilcoxon test) had a statistically significant difference (p = 0.043). CONCLUSIONS: Based on this preliminary clinical study, we conclude that the O-arm is capable of providing intraoperative x-ray 3D images in sufficient spatial resolution in a clinically feasible acquisition. The mean error of accuracy during intraoperative navigation, based on 3D O-arm scans at the skull base, is significantly lower compared to the usage of navigation using conventional presurgical CT and MRI images. This suggests the suitability of this method for utilization during endoscopic endonasal skull base approaches.


Assuntos
Adenoma , Hipófise , Neoplasias Hipofisárias , Base do Crânio , Cirurgia Assistida por Computador , Cirurgia Endoscópica Transanal , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Adulto , Idoso , Feminino , Humanos , Imageamento Tridimensional , Período Intraoperatório , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuronavegação/métodos , Projetos Piloto , Hipófise/diagnóstico por imagem , Hipófise/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgia , Estudos Prospectivos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Cirurgia Endoscópica Transanal/métodos
4.
Cochrane Database Syst Rev ; 1: CD013630, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33428222

RESUMO

BACKGROUND: Multiple studies have identified the prognostic relevance of extent of resection in the management of glioma. Different intraoperative technologies have emerged in recent years with unknown comparative efficacy in optimising extent of resection. One previous Cochrane Review provided low- to very low-certainty evidence in single trial analyses and synthesis of results was not possible. The role of intraoperative technology in maximising extent of resection remains uncertain. Due to the multiple complementary technologies available, this research question is amenable to a network meta-analysis methodological approach. OBJECTIVES: To establish the comparative effectiveness and risk profile of specific intraoperative imaging technologies using a network meta-analysis and to identify cost analyses and economic evaluations as part of a brief economic commentary. SEARCH METHODS: We searched CENTRAL (2020, Issue 5), MEDLINE via Ovid to May week 2 2020, and Embase via Ovid to 2020 week 20. We performed backward searching of all identified studies. We handsearched two journals, Neuro-oncology and the Journal of Neuro-oncology from 1990 to 2019 including all conference abstracts. Finally, we contacted recognised experts in neuro-oncology to identify any additional eligible studies and acquire information on ongoing randomised controlled trials (RCTs). SELECTION CRITERIA: RCTs evaluating people of all ages with presumed new or recurrent glial tumours (of any location or histology) from clinical examination and imaging (computed tomography (CT) or magnetic resonance imaging (MRI), or both). Additional imaging modalities (e.g. positron emission tomography, magnetic resonance spectroscopy) were not mandatory. Interventions included fluorescence-guided surgery, intraoperative ultrasound, neuronavigation (with or without additional image processing, e.g. tractography), and intraoperative MRI. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the search results for relevance, undertook critical appraisal according to known guidelines, and extracted data using a prespecified pro forma. MAIN RESULTS: We identified four RCTs, using different intraoperative imaging technologies: intraoperative magnetic resonance imaging (iMRI) (2 trials, with 58 and 14 participants); fluorescence-guided surgery with 5-aminolevulinic acid (5-ALA) (1 trial, 322 participants); and neuronavigation (1 trial, 45 participants). We identified one ongoing trial assessing iMRI with a planned sample size of 304 participants for which results are expected to be published around winter 2020. We identified no published trials for intraoperative ultrasound. Network meta-analyses or traditional meta-analyses were not appropriate due to absence of homogeneous trials across imaging technologies. Of the included trials, there was notable heterogeneity in tumour location and imaging technologies utilised in control arms. There were significant concerns regarding risk of bias in all the included studies. One trial of iMRI found increased extent of resection (risk ratio (RR) for incomplete resection was 0.13, 95% confidence interval (CI) 0.02 to 0.96; 49 participants; very low-certainty evidence) and one trial of 5-ALA (RR for incomplete resection was 0.55, 95% CI 0.42 to 0.71; 270 participants; low-certainty evidence). The other trial assessing iMRI was stopped early after an unplanned interim analysis including 14 participants; therefore, the trial provided very low-quality evidence. The trial of neuronavigation provided insufficient data to evaluate the effects on extent of resection. Reporting of adverse events was incomplete and suggestive of significant reporting bias (very low-certainty evidence). Overall, the proportion of reported events was low in most trials and, therefore, issues with power to detect differences in outcomes that may or may not have been present. Survival outcomes were not adequately reported, although one trial reported no evidence of improvement in overall survival with 5-ALA (hazard ratio (HR) 0.82, 95% CI 0.62 to 1.07; 270 participants; low-certainty evidence). Data for quality of life were only available for one study and there was significant attrition bias (very low-certainty evidence). AUTHORS' CONCLUSIONS: Intraoperative imaging technologies, specifically 5-ALA and iMRI, may be of benefit in maximising extent of resection in participants with high-grade glioma. However, this is based on low- to very low-certainty evidence. Therefore, the short- and long-term neurological effects are uncertain. Effects of image-guided surgery on overall survival, progression-free survival, and quality of life are unclear. Network and traditional meta-analyses were not possible due to the identified high risk of bias, heterogeneity, and small trials included in this review. A brief economic commentary found limited economic evidence for the equivocal use of iMRI compared with conventional surgery. In terms of costs, one non-systematic review of economic studies suggested that, compared with standard surgery, use of image-guided surgery has an uncertain effect on costs and that 5-ALA was more costly. Further research, including completion of ongoing trials of ultrasound-guided surgery, is needed.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Glioma/diagnóstico por imagem , Glioma/cirurgia , Ácido Aminolevulínico/administração & dosagem , Viés , Humanos , Cuidados Intraoperatórios , Imagem por Ressonância Magnética Intervencionista/estatística & dados numéricos , Metanálise em Rede , Neuronavegação/métodos , Neuronavegação/estatística & dados numéricos , Imagem Óptica/métodos , Imagem Óptica/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos
5.
Turk Neurosurg ; 31(1): 142-147, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33372259

RESUMO

AIM: To present one-step customized cranioplasty for intraosseous meningiomas. CASE DESCRIPTION: The authors report the case of a 54-year-old woman with a consequent frontal intraosseous meningioma invading the superior sagittal sinus. The patient only suffered from local pain and cosmetic damage. A complete resection was scheduled with a one-step reconstruction of the frontal bone by a polyetheretherketone (PEEK) specific implant. This implant was computer-assisted designed and manufactured and verified by the surgeon before the intervention. During surgery, the resection was guided by a computer designed resection template and by the classic neuronavigation system. Cranioplasty has been considered optimal intraoperatively by surgeons. The patient, a few weeks after surgery, underwent a subcutaneous fluid collection, rapidly resolutive with a circumferential pressure bandage. Six months after surgery, the patient considered the surgery a success with a very good cosmetic result and a total regression of her local pain. CONCLUSION: One-step computer-assisted cranioplasty is a safe and effective procedure for large skull defects. PEEK specific implant for cranioplasty offer advantages compared to other materials that will be discussed under the scope of the one-step reconstruction.


Assuntos
Cetonas/administração & dosagem , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Polietilenoglicóis/administração & dosagem , Impressão Tridimensional , Próteses e Implantes , Neoplasias Cranianas/cirurgia , Materiais Biocompatíveis/administração & dosagem , Feminino , Osso Frontal/diagnóstico por imagem , Osso Frontal/cirurgia , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/diagnóstico por imagem , Pessoa de Meia-Idade , Neuronavegação/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/diagnóstico por imagem , Crânio/cirurgia , Neoplasias Cranianas/diagnóstico por imagem
6.
Medicine (Baltimore) ; 99(44): e22468, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126302

RESUMO

RATIONAL: Vertebral compression fracture (VCF) is one of the most common diseases in spinal surgery. Traditional percutaneous vertebroplasty (PVP) under fluoroscopy is an effective method to treat vertebral compression fracture. However, there is still a risk of vascular nerve injury and infection caused by inaccurate or repeated puncture. Therefore, the purpose of this paper was to assess the accuracy of unilateral PVP guided by screw view model of navigation (SVMN) for VCF. PATIENT CONCERNS: A 59-year-old female patient suffered high falling injury, and with back pain as its main clinical symptom. DIAGNOSES: The patient was diagnosed with a L1 VCF. INTERVENTIONS: We placed the puncture needle under the guidance of SVMN to reach the ideal position designed before operation, and then injected the bone cement to complete the percutaneous kyphoplasty (PKP). OUTCOMES: The operative time was 29.5 minutes, the puncture time was 1 time, the fluoroscopy time was 2.9 minutes, and the bone cement distribution was satisfactory. VAS and ODI scores were significant improved postoperatively. No surgical complications, including neurovascular injury and infection, were observed during 28-month follow up. LESSONS: The SVMN guided percutaneous puncture needle insertion in PKP operation for VCF is an effective and safety technique. Besides, the SVMN has also been a contributor to reduce radiation doses and replace conventional fluoroscopy.


Assuntos
Fraturas por Compressão/cirurgia , Vértebras Lombares/lesões , Neuronavegação/métodos , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Cimentos para Ossos , Feminino , Humanos , Cifoplastia/métodos , Pessoa de Meia-Idade , Punções/métodos , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(36): e22029, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899058

RESUMO

This study aims to describe the role of open surgical treatment for focal brainstem gliomas (FBSGs) with the assistance of multimodal neuronavigation and intraoperative neurophysiological monitoring (IOM) in children to investigate the efficacy of microsurgical treatment in pediatric FBSGs. Also the prognostic factors related to the overall survival (OS) of FBSGs to describe the patient and tumor characteristics relevant to prognosis/outcome were focused on. Clinical data of 63 pediatric patients below 16 years of age with FBSGs admitted to the Neurosurgical Unit of Beijing Tiantan Hospital from January 2012 to December 2018 were retrospectively analyzed. All patients underwent initial surgical treatment, followed by magnetic resonance diffusion tensor imaging (DTI), neuronavigation and IOM. Gross or near total resection (GTR or NTR) was achieved in 57/63 (90.5%) cases, and subtotal resection (STR) was achieved in 6/63 (9.5%) cases. Postoperative adjuvant therapy was received by 27/63 (42.9%) cases. Postoperative pathological examination revealed that 36/63 (57.1%) cases had grade I gliomas, 22/63 (34.9%) had grade II, and 5/63 (8.0%) had grade III-IV gliomas according to the WHO classification. The mean Karnofsky score preoperatively was 60, and at the time of follow-up was 90. Consecutively, 6 cases demonstrated disease progression, and 5 of these were deceased. The OS in all patients was 81.2% at 5 years. Histological grade (P < .001) and age at diagnosis (P = .023) showed significant association with prolonged OS. Multimodal neuronavigation and IOM allow very precise intracranial surgery, contributing to a maximally safe resection that might decrease the postoperative disability and mortality rate. This study also showed that pediatric FBSGs were mostly low-grade tumors with excellent surgical outcomes. Consequently, it is suggested that microsurgery can be used to treat FBSGs in children in order to provide better prognosis and survival outcomes.


Assuntos
Neoplasias do Tronco Encefálico/patologia , Glioma/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Neuronavegação/métodos , Adolescente , Quimioterapia Adjuvante , Criança , Pré-Escolar , China/epidemiologia , Imagem de Tensor de Difusão/métodos , Progressão da Doença , Feminino , Glioma/diagnóstico por imagem , Humanos , Lactente , Avaliação de Estado de Karnofsky , Masculino , Microcirurgia/métodos , Gradação de Tumores , Cuidados Pós-Operatórios , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
8.
J Stroke Cerebrovasc Dis ; 29(9): 105050, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807458

RESUMO

OBJECTIVES: Endoscopic hematoma removal is widely performed for the treatment of intracerebral hemorrhage. We investigated the factors related to the prognosis of intracerebral hemorrhage after endoscopic hematoma removal. MATERIALS AND METHODS: From 2013 to 2019, we retrospectively analyzed 75 consecutive patients with hypertensive intracerebral hemorrhage who underwent endoscopic hematoma removal. Their characteristics, including neurological symptoms, laboratory data, and radiological findings were investigated using univariate and multivariate analysis. Complications during hospitalization, Glasgow Coma Scale (GCS) score on day 7, and modified Rankin Scale (mRS) score at 6 months were considered as treatment outcomes. RESULTS: The mean age of the patients (33 women, 42 men) was 71.8 (36-95) years. Mean GCS scores at admission and on day 7 were 10.3 ± 3.2 and 11.7 ± 3.8, respectively. The mean mRS score at 6 months was 3.8 ± 1.6, and poor outcome (mRS score ranging from 3 to 6 at 6 months) in 53 patients. Rebleeding occurred in 4 patients, and other complications in 15 patients. Multivariate analysis revealed that older age, hematoma in the basal ganglia, lower total protein level, higher glucose level, and absence of neuronavigation were associated with poor outcomes. Of the 75 patients, 9 had cerebellar hemorrhages, and they had relatively favorable outcomes compared to those with supratentorial hemorrhages. CONCLUSION: Several factors were related to the prognosis of intracerebral hemorrhage after endoscopic hematoma removal. Lower total protein level at admission and absence of neuronavigation were novel factors related to poor outcomes of endoscopic hematoma removal for intracerebral hemorrhage.


Assuntos
Proteínas Sanguíneas/metabolismo , Endoscopia/efeitos adversos , Hematoma/cirurgia , Hemorragia Intracraniana Hipertensiva/cirurgia , Neuronavegação , Estado Nutricional , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Hematoma/sangue , Hematoma/diagnóstico por imagem , Humanos , Hemorragia Intracraniana Hipertensiva/sangue , Hemorragia Intracraniana Hipertensiva/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
J Vis Exp ; (161)2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-32744518

RESUMO

The blood-brain barrier (BBB) has been a major hurdle for the treatment of various brain diseases. Endothelial cells, connected by tight junctions, form a physiological barrier preventing large molecules (>500 Da) from entering the brain tissue. Microbubble-mediated focused ultrasound (FUS) can be used to induce a transient local BBB opening, allowing larger drugs to enter the brain parenchyma. In addition to large-scale clinical devices for clinical translation, preclinical research for therapy response assessment of drug candidates requires dedicated small animal ultrasound setups for targeted BBB opening. Preferably, these systems allow high-throughput workflows with both high-spatial precision as well as integrated cavitation monitoring, while still being cost effective in both initial investment and running costs. Here, we present a bioluminescence and X-ray guided stereotactic small animal FUS system that is based on commercially available components and fulfills the aforementioned requirements. A particular emphasis has been placed on a high degree of automation facilitating the challenges typically encountered in high-volume preclinical drug evaluation studies. Examples of these challenges are the need for standardization in order to ensure data reproducibility, reduce intra-group variability, reduce sample size and thus comply with ethical requirements and decrease unnecessary workload. The proposed BBB system has been validated in the scope of BBB opening facilitated drug delivery trials on patient-derived xenograft models of glioblastoma multiforme and diffuse midline glioma.


Assuntos
Barreira Hematoencefálica/diagnóstico por imagem , Imageamento Tridimensional/métodos , Neuronavegação/métodos , Ultrassonografia/métodos , Animais , Modelos Animais de Doenças , Humanos , Camundongos , Roedores
12.
Artigo em Russo | MEDLINE | ID: mdl-32759931

RESUMO

Literature review is devoted to the role of frameless neuronavigation in surgery of distal aneurysms, cavernomas, arteriovenous malformations, Kimmerle's anomaly and revascularization surgeries. Visualization methods used in preoperative preparation of patients with vascular lesions compatible with frameless neuronavigation and the methods of intraoperative visualization as an addition to navigation are described.


Assuntos
Atlas Cervical , Hemangioma Cavernoso , Neurocirurgia , Humanos , Neuronavegação , Procedimentos Neurocirúrgicos
13.
PLoS One ; 15(7): e0233988, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32615583

RESUMO

Light touch with an earth-fixed reference point improves balance during quite standing. In our current study, we implemented a paradigm to assess the effects of disrupting the right posterior parietal cortex on dynamic stabilization of body sway with and without Light Touch after a graded, unpredictable mechanical perturbation. We hypothesized that the benefit of Light Touch would be amplified in the more dynamic context of an external perturbation, reducing body sway and muscle activations before, at and after a perturbation. Furthermore, we expected sway stabilization would be impaired following disruption of the right Posterior Parietal Cortex as a result of increased postural stiffness. Thirteen young adults stood blindfolded in Tandem-Romberg stance on a force plate and were required either to keep light fingertip contact to an earth-fixed reference point or to stand without fingertip contact. During every trial, a robotic arm pushed a participant's right shoulder in medio-lateral direction. The testing consisted of 4 blocks before TMS stimulation and 8 blocks after, which alternated between Light Touch and No Touch conditions. In summary, we found a strong effect of Light Touch, which resulted in improved stability following a perturbation. Light Touch decreased the immediate sway response, steady state sway following re-stabilization, as well as muscle activity of the Tibialis Anterior. Furthermore, we saw gradual decrease of muscle activity over time, which indicates an adaptive process following exposure to repetitive trials of perturbations. We were not able to confirm our hypothesis that disruption of the rPPC leads to increased postural stiffness. However, after disruption of the rPPC, muscle activity of the Tibialis Anterior is decreased more compared to sham. We conclude that rPPC disruption enhanced the intra-session adaptation to the disturbing effects of the perturbation.


Assuntos
Lobo Parietal/fisiologia , Equilíbrio Postural/fisiologia , Tato/fisiologia , Adulto , Mapeamento Encefálico , Retroalimentação Sensorial , Feminino , Humanos , Masculino , Contração Muscular , Neuronavegação , Pressão , Estresse Mecânico , Estimulação Magnética Transcraniana , Adulto Jovem
14.
Recent Results Cancer Res ; 216: 813-841, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32594408

RESUMO

In neurosurgery, the extent of resection plays a critical role, especially in the management of malignant gliomas. These tumors are characterized through a diffuse infiltration into the surrounding brain parenchyma. Delineation between tumor and normal brain parenchyma can therefore often be challenging. During the recent years, several techniques, aiming at better intraoperative tumor visualization, have been developed and implemented in the field of brain tumor surgery. In this chapter, we discuss current strategies for intraoperative imaging in brain tumor surgery, comprising conventional techniques such as neuronavigation, techniques using fluorescence-guided surgery, and further highly precise developments such as targeted fluorescence spectroscopy or Raman spectroscopy.


Assuntos
Encéfalo/cirurgia , Neuronavegação , Cirurgia Assistida por Computador , Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Humanos
15.
World Neurosurg ; 139: e626-e634, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32339734

RESUMO

OBJECTIVE: To evaluate the position of the aorta relative to the spine and the risk of aortic injury during correction surgery in patients with idiopathic severe and rigid scoliosis (main curve Cobb angle >90° and flexibility <30%). METHODS: Twenty-seven patients with severe right thoracic/thoracolumbar scoliosis were recruited. The entry point-aorta distance (EAD), the left pedicle-aorta angle (α), the left aorta angle (ß), and the vertebral rotation angle (γ) were measured from 4 vertebrae above (A4) to 4 below (B4) the apical vertebra (Apex) to quantify the spatial relationship between aorta and spine. We simulated the pedicle screw misplacement with variable direction error, length, and diameter to analyze the potential risk of aortic injury. RESULTS: The aorta shifted laterally and posteriorly as it descended from A4 and moved back medially and anteriorly from Apex. The potential risk of aortic injury increased with the augment of direction error and/or length of the screw, but the tendency was not significant with the augment of diameter. The risk peaked at A4, A3, and B2, when the screw length was 40 mm and diameter was 5.0 mm, and the direction error was 30°, whereas the risk was lowest at the apical level 14.3% (0%-40.7%) in any scenarios. CONCLUSIONS: In patients with severe and rigid scoliosis, the aorta shifted more laterally and posteriorly, and the injury risk was lower at the apical level, compared with moderate scoliosis. Most potential risks can be minimized by careful preoperative planning and the assistance of intraoperative navigation or robotics.


Assuntos
Aorta/lesões , Complicações Intraoperatórias/etiologia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Escoliose/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Vértebras Lombares , Masculino , Neuronavegação , Parafusos Pediculares , Escoliose/complicações , Escoliose/diagnóstico por imagem , Fusão Vertebral , Vértebras Torácicas , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Int J Comput Assist Radiol Surg ; 15(6): 1013-1021, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32323206

RESUMO

PURPOSE: Neuronavigation systems making use of augmented reality (AR) have been the focus of much research in the last couple of decades. In recent years, there has been considerable interest in using mobile devices for AR in the operating room (OR). We propose a complete system that performs real-time AR video augmentation on a mobile device in the context of image-guided neurosurgery. METHODS: MARIN (mobile augmented reality interactive neuronavigation system) improves upon the state of the art in terms of performance, allowing real-time augmentation, and interactivity by allowing users to interact with the displayed data. The system was tested in a user study with 17 subjects for qualitative and quantitative evaluation in the context of target localization and brought into the OR for preliminary feasibility tests, where qualitative feedback from surgeons was obtained. RESULTS: The results of the user study showed that MARIN performs significantly better in terms of both time ([Formula: see text]) and accuracy ([Formula: see text]) for the task of target localization in comparison with a traditional image-guided neurosurgery (IGNS) navigation system. Further, MARIN AR visualization was found to be more intuitive and allowed users to estimate target depth more easily. CONCLUSION: MARIN improves upon previously proposed mobile AR neuronavigation systems with its real-time performance, higher accuracy, full integration in the normal workflow and greater interactivity and customizability of the displayed information. The improvement in efficiency and usability over previous systems will facilitate bringing AR into the OR.


Assuntos
Realidade Aumentada , Neuronavegação/métodos , Procedimentos Neurocirúrgicos/métodos , Humanos , Salas Cirúrgicas , Cirurgia Assistida por Computador/métodos , Fluxo de Trabalho
17.
World Neurosurg ; 139: 186-195, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32311561

RESUMO

OBJECTIVE: Augmented reality (AR) is increasingly being explored as an adjunct to conventional neuronavigation systems. AR affords the ability to superimpose 3-dimensional images onto the real environment. A natural extension of this technology is to help guide neurosurgical planning and a means of stereotactic planning and guidance. Here we review the literature on the use of AR in neurosurgery with a focus on current technologies and limitations. Furthermore, we discuss this technology in the context of neurosurgical training as an educational tool. METHODS: PubMed search was performed for "augmented reality and neurosurgery" and "mixed reality and neurosurgery" from 2010. A total of 113 articles written in the last 5 years were retrieved, and 39 were ultimately included in the systematic review. RESULTS: The most common use of AR in neurosurgery was in cranial surgery (n = 26). Other uses included spine surgery (n = 9) and education (n = 2). Devices used for display of AR images varied as did image-to-patient registration methods and overall system accuracy. CONCLUSIONS: Although various AR systems have been successfully utilized across many neurosurgical disciplines, more research is needed to improve accuracy in registration and to assess whether AR-assisted surgery is safe and effective for widespread adoption.


Assuntos
Realidade Aumentada , Neuronavegação/métodos , Procedimentos Neurocirúrgicos/métodos , Neoplasias Encefálicas/cirurgia , Humanos , Neurocirurgia/educação , Procedimentos Neurocirúrgicos/educação , Óculos Inteligentes , Doenças da Coluna Vertebral/cirurgia , Técnicas Estereotáxicas , Procedimentos Cirúrgicos Vasculares/métodos , Ventriculostomia/métodos , Fluxo de Trabalho
18.
World Neurosurg ; 139: e182-e188, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32272275

RESUMO

OBJECTIVE: This study aimed to report the technical advancement to improve the accuracy of cervical pedicle screw (CPS) placement using O-arm-based 3D navigation. METHODS: Sixty-four patients who underwent CPS using O-arm in the spine level of C2 to C7 between June 2013 and February 2020 were involved. In the first phase, a reference frame was placed onto the spinous process of the cranial vertebrae and used it at a maximum of 3 vertebral levels. The navigation guide sleeve was used to drill a screw hole. In the second phase, a reference frame that can hold 3 vertebrae was introduced. In the third phase, a drill guide sleeve to minimize bending of the drill tip was developed. In the fourth phase, navigated surgical drill was introduced. Screw accuracy was assessed using Neo classification: grade (G) 0, no perforation; G1, perforation <2 mm; G2, perforation 2-4 mm; and G3, perforation >4 mm. RESULTS: Mean age at surgery was 67 (19-88) years. A total of 317 CPSs were inserted. In total, 83 screws were inserted in the first phase, 60 in the second phase, 87 in the third phase, and 87 in the fourth phase. The total proportion of malpositioning was 3.8% (12/317 screws) and all were G1; 6.0% (5/83 screws) in the first phase, 8.3% (5/60 screws) in the second phase, 1.2% (1/87 screws) in the third phase, and 1.2% (1/87 screws) in the fourth phase (P < 0.05). CONCLUSIONS: O-arm use improved CPS placement accuracy with the advancement of techniques and instruments.


Assuntos
Imageamento Tridimensional/métodos , Neuronavegação/instrumentação , Neuronavegação/métodos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Doenças da Coluna Vertebral/cirurgia , Adulto Jovem
19.
Spine (Phila Pa 1976) ; 45(8): E465-E476, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32224807

RESUMO

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To describe our technique for and evaluate the time demand, radiation exposure and outcomes of skin-anchored intraoperative three-dimensional navigation (ION) in minimally invasive (MIS) lumbar surgery, and to compare these parameters to 2D fluoroscopy for MI-TLIF. SUMMARY OF BACKGROUND DATA: Limited visualization of anatomic landmarks and narrow access corridor in MIS procedures result in greater reliance on image guidance. Although two-dimensional fluoroscopy has historically been used, ION is gaining traction. METHODS: Patients who underwent MIS lumbar microdiscectomy, laminectomy, or MI-TLIF using skin-anchored ION and MI-TLIF by the same surgeon using 2D fluoroscopy were selected. Operative variables, radiation exposure, and short-term outcomes of all procedures were summarized. Time-demand and radiation exposure of fluoroscopy and ION for MI-TLIF were compared. RESULTS: Of the 326 patients included, 232 were in the ION cohort (92 microdiscectomies, 65 laminectomies, and 75 MI-TLIFs) and 94 in the MI-TLIF using 2D fluoroscopy cohort. Time for ION setup and image acquisition was a median of 22 to 24 minutes. Total fluoroscopy time was a median of 10 seconds for microdiscectomy, 9 for laminectomy, and 26 for MI-TLIF. Radiation dose was a median of 15.2 mGy for microdiscectomy, 16.6 for laminectomy, and 44.6 for MI-TLIF, of this, 93%, 95%, and 37% for microdiscectomy, laminectomy, and MI-TLIF, respectively were for ION image acquisition, with the rest attributable to the procedure. There were no wrong-level surgeries. Compared with fluoroscopy, ION for MI-TLIF resulted in lower operative times (92 vs. 108 min, P < 0.0001), fluoroscopy time (26 vs. 144 s, P < 0.0001), and radiation dose (44.6 vs. 63.1 mGy, P = 0.002), with equivalent time-demand and length of stay. ION lowered the radiation dose by 29% for patients and 55% for operating room personnel. CONCLUSION: Skin-anchored ION does not increase time-demand compared with fluoroscopy, is feasible, safe and accurate, and results in low radiation exposure. LEVEL OF EVIDENCE: 3.


Assuntos
Imageamento Tridimensional/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Exposição à Radiação , Adulto , Idoso , Estudos de Coortes , Discotomia/efeitos adversos , Discotomia/métodos , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Humanos , Imageamento Tridimensional/efeitos adversos , Monitorização Neurofisiológica Intraoperatória/efeitos adversos , Laminectomia/efeitos adversos , Laminectomia/métodos , Vértebras Lombares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Neuronavegação/efeitos adversos , Neuronavegação/métodos , Estudos Prospectivos , Exposição à Radiação/efeitos adversos , Estudos Retrospectivos , Pele/diagnóstico por imagem , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos
20.
Epilepsia ; 61(5): 841-855, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32227349

RESUMO

This article emphasizes the role of the technological progress in changing the landscape of epilepsy surgery and provides a critical appraisal of robotic applications, laser interstitial thermal therapy, intraoperative imaging, wireless recording, new neuromodulation techniques, and high-intensity focused ultrasound. Specifically, (a) it relativizes the current hype in using robots for stereo-electroencephalography (SEEG) to increase the accuracy of depth electrode placement and save operating time; (b) discusses the drawback of laser interstitial thermal therapy (LITT) when it comes to the need for adequate histopathologic specimen and the fact that the concept of stereotactic disconnection is not new; (c) addresses the ratio between the benefits and expenditure of using intraoperative magnetic resonance imaging (MRI), that is, the high technical and personnel expertise needed that might restrict its use to centers with a high case load, including those unrelated to epilepsy; (d) soberly reviews the advantages, disadvantages, and future potentials of neuromodulation techniques with special emphasis on the differences between closed and open-loop systems; and (e) provides a critical outlook on the clinical implications of focused ultrasound, wireless recording, and multipurpose electrodes that are already on the horizon. This outlook shows that although current ultrasonic systems do have some limitations in delivering the acoustic energy, further advance of this technique may lead to novel treatment paradigms. Furthermore, it highlights that new data streams from multipurpose electrodes and wireless transmission of intracranial recordings will become available soon once some critical developments will be achieved such as electrode fidelity, data processing and storage, heat conduction as well as rechargeable technology. A better understanding of modern epilepsy surgery will help to demystify epilepsy surgery for the patients and the treating physicians and thereby reduce the surgical treatment gap.


Assuntos
Epilepsia/cirurgia , Procedimentos Cirúrgicos Robóticos/instrumentação , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Eletroencefalografia/instrumentação , Eletroencefalografia/métodos , Ablação por Ultrassom Focalizado de Alta Intensidade/instrumentação , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Humanos , Fotocoagulação a Laser/instrumentação , Fotocoagulação a Laser/métodos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Imagem por Ressonância Magnética Intervencionista/instrumentação , Imagem por Ressonância Magnética Intervencionista/métodos , Neuronavegação/instrumentação , Neuronavegação/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Robótica
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