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1.
Bone Joint J ; 102-B(1): 5-10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888369

RESUMO

AIMS: Intraoperative 3D navigation (ION) allows high accuracy to be achieved in spinal surgery, but poor workflow has prevented its widespread uptake. The technical demands on ION when used in patients with adolescent idiopathic scoliosis (AIS) are higher than for other more established indications. Lean principles have been applied to industry and to health care with good effects. While ensuring optimal accuracy of instrumentation and safety, the implementation of ION and its associated productivity was evaluated in this study for AIS surgery in order to enhance the workflow of this technique. The aim was to optimize the use of ION by the application of lean principles in AIS surgery. METHODS: A total of 20 consecutive patients with AIS were treated with ION corrective spinal surgery. Both qualitative and quantitative analysis was performed with real-time modifications. Operating time, scan time, dose length product (measure of CT radiation exposure), use of fluoroscopy, the influence of the reference frame, blood loss, and neuromonitoring were assessed. RESULTS: The greatest gains in productivity were in avoiding repeat intraoperative scans (a mean of 248 minutes for patients who had two scans, and a mean 180 minutes for those who had a single scan). Optimizing accuracy was the biggest factor influencing this, which was reliant on incremental changes to the operating setup and technique. CONCLUSION: The application of lean principles to the introduction of ION for AIS surgery helps assimilate this method into the environment of the operating theatre. Data and stakeholder analysis identified a reproducible technique for using ION for AIS surgery, reducing operating time, and radiation exposure. Cite this article: Bone Joint J. 2020;102-B(1):5-10.


Assuntos
Neuronavegação/métodos , Escoliose/cirurgia , Adolescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Parafusos Ósseos/estatística & dados numéricos , Desenho de Equipamento , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Bloqueadores Neuromusculares/administração & dosagem , Neuronavegação/instrumentação , Duração da Cirurgia , Posicionamento do Paciente , Doses de Radiação , Resultado do Tratamento
2.
World Neurosurg ; 130: 593-607, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31581409

RESUMO

Stereotactic radiosurgery is a modern discipline that emerged after World War II. It represents a synthesis of an approach to patient care that was not immediately embraced by either neurosurgeons or radiation oncologists, but which has been shown, time and again, to be advantageous for the treatment of intracranial pathology. Indeed, stereotactic radiosurgical techniques are now being rapidly adapted and adopted for the treatment of extracranial malignant and benign disease. Any examination of the individuals, devices, and technological advances that permitted stereotactic radiosurgery to become a preferred approach for patient care cannot be absolutely comprehensive but can provide insights into the evolution of the specialty and potential future prospects for further improvements in patient care. As Shakespeare wrote in The Tempest, "What's past is prologue."


Assuntos
Neurocirurgia/história , Radiocirurgia/história , História do Século XX , Humanos , Neuronavegação/história , Neuronavegação/instrumentação , Neurocirurgia/instrumentação , Radiocirurgia/instrumentação
3.
World Neurosurg ; 131: 339-345, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31284061

RESUMO

Cylindrical tubular ports are among the most innovative dynamic tools added to the neurosurgery armamentarium. The rationale behind the use of tubular systems lies in the knowledge that damage to surrounding tissues is minimized with the equal pressure exerted by the walls of the cylinder. A microscope or an endoscope is used for visualization in the tubular ports. Neuronavigation is an essential adjuvant to ensure avoiding injury to essential brain tracts and parenchyma. In the present report, we focused on 3 commonly used cylindrical retractor systems, including the ViewSite, BrainPath, and syringe port. The custom-made syringe port system is used by us and is cost effective. It costs only the price of a syringe. The efficacy and safety of tubular port systems have been shown in limited studies. The complications associated with the port system have been minimal, and injury to the brain has been reduced by the equal pressure exerted by the walls of the port.


Assuntos
Encefalopatias/cirurgia , Neuroendoscopia/instrumentação , Remoção de Dispositivo/métodos , Humanos , Imagem por Ressonância Magnética , Microcirurgia/instrumentação , Microcirurgia/métodos , Neuroendoscópios , Neuroendoscopia/métodos , Neuronavegação/instrumentação , Instrumentos Cirúrgicos , Seringas
4.
Ann Otol Rhinol Laryngol ; 128(10): 894-902, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31067988

RESUMO

OBJECTIVE: Navigation systems create a connection between imaging data and intraoperative situs, allowing the surgeon to consistently determine the location of instruments and patient anatomy during the surgical procedure. The best results regarding the target registration error (measurement uncertainty) are normally demonstrated using fiducials. This study aimed at investigating a new registration strategy for an electromagnetic navigation device. METHODS: For evaluation of an electromagnetic navigation system and comparison of registration with screw markers and automatic registration, we are calculating the target registration error in the region of the paranasal sinuses/anterior and lateral skull base with the use of an electromagnetic navigation system and intraoperative digital volume tomography (cone-beam computed tomography). We carried out 10 registrations on a head model (total n = 150 measurements) and 10 registrations on 4 temporal bone specimens (total n = 160 measurements). RESULTS: All in all, the automatic registration was easy to perform. For the models that were used, a significant difference between an automatic registration and the registration on fiducials was evident for just a limited number of screws. Furthermore, the observed differences varied in terms of the preferential registration procedure. CONCLUSION: The automatic registration strategy seems to be an alternative to the established methods in artificial and cadaver models of intraoperative scenarios. Using intraoperative imaging, there is an option to resort to this kind of registration as needed.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Campos Eletromagnéticos , Neuronavegação/instrumentação , Neuronavegação/métodos , Base do Crânio/cirurgia , Cirurgia Assistida por Computador/métodos , Parafusos Ósseos , Cadáver , Marcadores Fiduciais , Humanos , Modelos Anatômicos , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/cirurgia , Interpretação de Imagem Radiográfica Assistida por Computador/instrumentação , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Base do Crânio/diagnóstico por imagem , Titânio
5.
World Neurosurg ; 127: 607-616.e4, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30974279

RESUMO

BACKGROUND: Frame-based stereotaxy has generally been considered the reference standard for brain biopsies. However, frameless stereotaxy might expedite the efficiency of the clinical work flow. Conflicting findings have been reported regarding the relative efficacy and safety of frame-based and frameless needle biopsy of brain lesions. We performed a meta-analysis of the reported data to compare the relative efficacy, safety, and time efficiency of frame-based and frameless stereotactic needle biopsy. METHODS: The PubMed database was searched for studies comparing frame-based and frameless biopsy. Of the 5248 reports found, 15 were included in the present meta-analysis. RESULTS: The 15 studies included in the present meta-analysis included 2400 patients. Our analysis found no statistically significant differences between frame-based and frameless biopsy in the diagnostic yield (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.71-1.41), morbidity (OR, 1.13; 95% CI, 0.76-1.66), mortality (OR, 0.94; 95% CI, 0.40-2.17), postbiopsy hemorrhage (OR, 1.16; 95% CI, 0.68-1.96), and postbiopsy neurological deficit (OR, 1.01; 95% CI, 0.62-1.65). The results from our integrated analysis indicated that frameless biopsies are associated with a shorter procedural time relative to frame-based biopsy (standard difference in the mean, 0.64; 95% CI, 0.24-1.04; P = 0.002; I2 [Higgins inconsistency index] = 86.66%). CONCLUSIONS: The results from our meta-analysis suggest no significant differences exist between frame-based and frameless biopsy in diagnostic yield, morbidity, and mortality. Frameless biopsy is associated with shorter procedural times relative to frame-based biopsy. We have also discussed the relative merits of frame-based and frameless biopsies.


Assuntos
Encéfalo/patologia , Neuronavegação/instrumentação , Biópsia/instrumentação , Biópsia/métodos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuronavegação/métodos , Duração da Cirurgia , Viés de Publicação , Instrumentos Cirúrgicos , Resultado do Tratamento
6.
J Neurointerv Surg ; 11(10): 1036-1039, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30878951

RESUMO

BACKGROUND: Endovascular technological advances have revolutionized the field of neurovascular surgery and have become the mainstay of treatment for many cerebrovascular pathologies. Digital subtraction angiography (DSA) is the 'gold standard' for visualization of the vasculature and deployment of endovascular devices. Nonetheless, with recent technological advances in optics, angioscopy has emerged as a potentially important adjunct to DSA. Angioscopy can offer direct visualization of the intracranial vasculature, and direct observation and inspection of device deployment. However, previous iterations of this technology have not been sufficiently miniaturized or practical for modern neurointerventional practice. OBJECTIVE: To describe the evolution, development, and design of a microangioscope that offers both high-quality direct visualization and the miniaturization necessary to navigate in the small intracranial vessels and provide examples of its potential applications in the diagnosis and treatment of cerebrovascular pathologies using an in vivo porcine model. METHODS: In this proof-of-concept study we introduce a novel microangioscope, designed from coherent fiber bundle technology. The microangioscope is smaller than any previously described angioscope, at 1.7 F, while maintaining high-resolution images. A porcine model is used to demonstrate the resolution of the images in vivo. RESULTS: Video recordings of the microangioscope show the versatility of the camera mounted on different microcatheters and its ability to navigate external carotid artery branches. The microangioscope is also shown to be able to resolve the subtle differences between red and white thrombi in a porcine model. CONCLUSION: A new microangioscope, based on miniaturized fiber optic technology, offers a potentially revolutionary way to visualize the intracranial vascular space.


Assuntos
Angioscopia/tendências , Desenho de Equipamento/tendências , Neuronavegação/tendências , Estudo de Prova de Conceito , Angiografia Digital/instrumentação , Angiografia Digital/métodos , Angiografia Digital/tendências , Angioscopia/instrumentação , Angioscopia/métodos , Animais , Desenho de Equipamento/métodos , Feminino , Tecnologia de Fibra Óptica/instrumentação , Tecnologia de Fibra Óptica/métodos , Tecnologia de Fibra Óptica/tendências , Humanos , Neuronavegação/instrumentação , Neuronavegação/métodos , Suínos
7.
World Neurosurg ; 126: 291-295, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30885874

RESUMO

BACKGROUND: Using a stereotactic technique, surgeons can accurately place a depth electrode (DE), but sometimes the DE deviates from the intended target due to movement of the electrode or leakage of cerebrospinal fluid when placing the electrode. If DEs can be anchored before removing the catheter insertion guide pipe, more accurate placement may be possible. METHODS: We made a side slit guide pipe. When the DEs were anchored to the dura or the edge of the burr hole, the DE did not move when the guide pipe was removed. We measured the distance between the planned target and the tip of the electrode in 13 patients (3 female and 10 male patients; age range, 7-43 years; mean age 23.0 years; median age 27 years) with medically intractable epilepsy who underwent DE placement with stereotactic neuronavigation guidance. RESULTS: There were 30 DEs implanted. The mean distance from the planned target to the tip of the DE was 0.570 mm (range, 0.3-1.2 mm; median 0.5 mm; SD 0.212). The mean distance from the planned target to the tip of the DE with dural anchoring was 0.467 mm (range, 0.3-0.6 mm; median 0.45 mm; SD 0.121) and with burr hole edge anchoring was 0.596 mm (range, 0.3-1.2 mm; median 0.50 mm; SD 0.224; P = 0.205). CONCLUSIONS: DEs can be anchored using the side slit guide pipe for more precise placement.


Assuntos
Encéfalo/cirurgia , Epilepsia Resistente a Medicamentos/cirurgia , Eletrodos Implantados , Neuronavegação/instrumentação , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Técnicas Estereotáxicas , Adulto Jovem
8.
World Neurosurg ; 125: e361-e371, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30703594

RESUMO

OBJECTIVE: For effective minimally invasive lumbar decompression, we changed the routine of segmental decompression. Using a high-speed drill or an ultrasound knife, we created a working channel, starting at the base of the spinous process of the upper vertebra slightly above the disc level, to target and decompress the contralateral recess, and termed it the translaminar crossover decompression (TCD). We evaluated the feasibility and compared the outcomes of a navigation-guided endoscopic translaminar crossover approach for segmental decompression (eTCD) in elderly patients with microscopic decompression using the same approach (mTCD). METHODS: A total of 740 elderly patients were enrolled in a prospective cohort study. Of the 740 patients, 297, who had undergone mTCD, and 253, who had undergone eTCD, completed a 1-year follow-up visit. In addition to the surgical data, numerical rating scales (NRSs) for back and leg pain, the Core Outcome Measures Index and Oswestry Disability Index were recorded preoperatively and 3, 6, and 12 months after surgery. The MacNab criteria were supplemented by qualitative assessment of the patients' postoperative pain-free walking distance. RESULTS: A comparison of the preoperative and postoperative clinical scores showed significant improvement after TCD in both cohorts (P < 0.01): Oswestry Disability Index, from 50.3% ± 12.6% to 15.5% ± 7.43%; NRS (back), from 6.9 ± 1.9 to 2.5 ± 1.3; NRS (leg), from 8.0 ± 0.85 to 1.6 ± 0.33; Core Outcome Measures Index (back), from 7.8 ± 2.0 to 2.7 ± 1.5. No statistically significant differences were found in the outcomes between the 2 cohorts. CONCLUSIONS: TCD inherently eliminated central stenosis and facilitated decompression of both recesses via mutual undercutting, with preservation of facet joint integrity.


Assuntos
Descompressão Cirúrgica/métodos , Neuroendoscopia/métodos , Estenose Espinal/cirurgia , Idoso , Dor nas Costas/etiologia , Dor nas Costas/cirurgia , Descompressão Cirúrgica/instrumentação , Avaliação da Deficiência , Desenho de Equipamento , Feminino , Humanos , Claudicação Intermitente/etiologia , Claudicação Intermitente/cirurgia , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Masculino , Microcirurgia/instrumentação , Microcirurgia/métodos , Neuroendoscopia/instrumentação , Neuronavegação/instrumentação , Neuronavegação/métodos , Estudos Prospectivos , Tomografia Computadorizada por Raios X
9.
World Neurosurg ; 126: e208-e218, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30797910

RESUMO

OBJECTIVE: Frame-based stereotaxy represents the gold standard for biopsy of deep-seated lesions. Visual control of possible bleeding in these lesions is not possible. Neuroendoscopic biopsy represents an alternative procedure for tissue sampling in deep-seated intraventricular lesions. The authors present a technique for transventricular-navigated endoscopic biopsy of lesions that are located in the paraventricular region. METHODS: Biopsy of paraventricular pathologies was performed in 6 male and 6 female patients between March 2013 and September 2018. The patient age ranged from 18 to 82 years. All patients underwent a pure endoscopic procedure over a burr hole trepanation supported by frameless navigation of the sedan probe. RESULTS: Histologic diagnoses were established in all biopsies. In all patients, a direct control of the biopsy area was feasible, and hemostasis could be obtained. In 5 patients, endoscopic third ventriculostomy was performed first due to obstructive hydrocephalus. In 1 patient suffering from obstructive hydrocephalus, a pellucidotomy was performed. In 9 cases, the initial postoperative course was uneventful. Three patients suffered from persistent hydrocephalus and had to be treated with ventriculoperitoneal shunt insertion. CONCLUSIONS: Endoscopically conducted biopsies with the aid of navigated tracking of the probe represent a possible additional technique in selected paraventricular intraparenchymal pathologies. The endoscopic approach enables the direct visualization of the intraventricular surface and its vessels. In contrast to standard stereotactic biopsy, direct visual control of hemostasis can be obtained even in paraventricular tumors.


Assuntos
Biópsia por Agulha/métodos , Neoplasias do Ventrículo Cerebral/patologia , Neuroendoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/instrumentação , Neoplasias do Ventrículo Cerebral/diagnóstico , Feminino , Humanos , Hidrocefalia/patologia , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/instrumentação , Neuronavegação/instrumentação , Neuronavegação/métodos , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Técnicas Estereotáxicas , Terceiro Ventrículo/patologia , Terceiro Ventrículo/cirurgia , Trepanação , Derivação Ventriculoperitoneal , Ventriculostomia , Adulto Jovem
10.
J Clin Neurosci ; 62: 277-281, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30612915

RESUMO

This article is aimed at investigating the use of smart phone software Sina in the localization of supratentorial lesions, finding the error between Sina method and neuronavigation, and identifying the reliability of the new method. Neuronavigation and Sina measurement were used to locate the lesion in the patients whose lesion lengths are between 2 cm and 6 cm. The reference point was the center of the lesion. We found the error of Sina method is 13.6 ±â€¯0.55 mm comparing with neuronavigation, so the Sina method still cannot replace the localization method of the neuronavigation system. However, in practical clinical work, with the help of the new method, the lesion can be located more precisely and easily.


Assuntos
Aplicativos Móveis , Neuronavegação , Smartphone , Neoplasias Supratentoriais/cirurgia , Cirurgia Assistida por Computador , Adulto , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuronavegação/instrumentação , Neuronavegação/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Adulto Jovem
11.
J Neurosurg Sci ; 63(2): 194-199, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26977636

RESUMO

BACKGROUND: The specificity of imaging alone in diagnosing posterior fossa lesions is insufficient, hence the importance of biopsy for diagnostic, therapeutic and prognostic purposes. Concerning the operative technique, many studies have demonstrated the superior safety of stereotactic biopsy over craniotomy and superior accuracy of frame-based systems over frameless ones as far as the posterior fossa is concerned; however versatile, frame-based instruments bear some intrinsic limitations in the positioning of frame in lower lesions mainly in short neck and kyphotic patients. For all these reasons, a more proficient technical bioptic approach to the posterior fossa and lower brainstem is sometimes required. METHODS: In order to obtain a specimen a Leksell System (Elekta®) constituted by the Leksell Coordinate G Frame (Article No: 014611), 4 adjustable posts (Article No: 1006476), 4 reusable screws (Article No: 1006581), an open indicator box (Article No: 1006559), a Leksell Multi-purpose Stereotactic Arc (Article No: 1008174) and a Sedan Needle (Article No: A2430-01) are required. RESULTS: This is a simple and reliable technique to obtain a brainstem/cerebellar specimen maintaining unchanged the know risks of the procedure, as well the morbidity and mortality. We otherwise recommend this procedure to be performed by a team of neurosurgeons trained in stereotaxy. CONCLUSIONS: If meticulously planned, our modified procedure provide a direct and precise access to deep seated areas of the posterior fossa and brainstem and is particularly helpful in those patients with short neck and kyphosis in which is crucial obtain an istopathologic diagnosis in lower posterior fossa.


Assuntos
Neoplasias do Tronco Encefálico/cirurgia , Neoplasias Infratentoriais/cirurgia , Neuronavegação/instrumentação , Neuronavegação/métodos , Técnicas Estereotáxicas/instrumentação , Biópsia/métodos , Humanos , Cirurgia Assistida por Computador/métodos
12.
World Neurosurg ; 122: e449-e454, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30347306

RESUMO

BACKGROUND: Navigation (image guidance) is an essential tool in modern neurosurgery, and most surgeons use an optical tracking system. Although the technology is accurate and reliable, one often is confronted by line of sight issues that interrupt the flow of an operation. There has been feedback on the matter, but the actual problem has not been accurately quantified, therefore making this the primary aim of this study. It is particularly important given that robotic technology is gradually making its way into neurosurgery and most of these devices depend on optical navigation when procedures are being conducted. METHODS: In this study, the frequency and causes of line of sight issues is assessed using recordings of Navigation probe locations and its synchronised video recordings. RESULTS: The mentioned experiment conducted for a series of 15 neurosurgical operations. This issue occured in all these surgeries except one. Maximum duration of issue presisting reached up to 56% of the navigation usage time. CONCLUSIONS: The arrangment of staff and equipment is a key factor in avoiding this issue.


Assuntos
Competência Clínica , Neuronavegação/métodos , Neurocirurgiões , Procedimentos Neurocirúrgicos/métodos , Imagem Óptica/métodos , Cirurgia Assistida por Computador/métodos , Humanos , Neuronavegação/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Imagem Óptica/instrumentação , Cirurgia Assistida por Computador/instrumentação
13.
Br J Neurosurg ; 33(3): 309-311, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29461094

RESUMO

Purpose: One of the most effective treatments for epilepsy is resection, but it remains underutilized. Efforts must be made to increase the ease, safety, and efficacy of epilepsy resection to improve utilization. Studies have shown an improved risk profile of stereoelectroencephalography (SEEG) over subdural grids (SDG) for invasive monitoring. One limitation to increased adoption of SEEG at epilepsy centers is the theoretical difficulty of planning a delayed resection once electrodes are removed. Our objective was to develop and present a technique using readily available neuronavigation technology to guide a cortical, non-lesional epilepsy resection with co-registration of imaging during invasive monitoring to imaging in an explanted patient, allowing for virtual visualization of electrodes. Methods: An example case taking advantage of the technique described above as an adjunct for an anatomically guided resection is presented with technical details and images. Results: Intraoperative neuronavigation was successfully used to virtually represent previously removed SEEG electrodes and accuracy could be easily verified by examining scars on the scalp, bone, dura and pia. Conclusions: The simple technique presented can be a useful adjunct to resection following SEEG. This may help increase the adoption of SEEG, even when resection is planned.


Assuntos
Epilepsia/radioterapia , Neuronavegação/instrumentação , Adulto , Osso e Ossos , Dura-Máter , Eletrodos Implantados , Eletroencefalografia/métodos , Epilepsia/cirurgia , Feminino , Humanos , Cuidados Intraoperatórios , Neuronavegação/métodos , Radiocirurgia/instrumentação , Radiocirurgia/métodos , Radioterapia Guiada por Imagem/instrumentação , Radioterapia Guiada por Imagem/métodos , Couro Cabeludo , Resultado do Tratamento
14.
J Neurointerv Surg ; 11(3): 271-274, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30177546

RESUMO

BACKGROUND: Despite high recanalization rates achieved with endovascular treatment of acute ischemic strokes, around 50% of eligible patients will not achieve a good outcome. Parameters that may determine patient outcomes include: time from puncture to recanalization, the collateral status, the anesthesia regimen, blood pressure management, and distal emboli. Characterization of distal emboli generated during mechanical thrombectomy has been performed in previous studies. OBJECTIVE: To further investigate the risk of distal embolization associated with microcatheter navigation across the clot. METHODS: A contrast-enhanced clot analog was used in an in vitro model that mimicked a middle cerebral artery occlusion within a complete circle of Willis vascular replica. The clot was crossed with one of the following microcatheters: Pro18, XT-27 or 3MAX. The emboli generated during the procedure were collected and measured. RESULTS: The use of Pro18 and XT-27 resulted in a significant reduction of visible particles (size ≥500 µm) as compared with the 3MAX catheter (P<0.003). For the size range between 8 and 200 µm, there was a trend for Pro18 to generate fewer particles (-18%) than XT-27 but without statistical significance (P>0.05). In comparison with previously published data, acquired under the same conditions, it was found that the clot crossing maneuver accounts approximately for 12% of the total number of small emboli (<200 µm) induced during a stent retriever-mediated mechanical thrombectomy procedure via a balloon guide catheter. CONCLUSIONS: The clot crossing maneuver has a significant effect on the total number of small particles induced during mechanical thrombectomy. Smaller microcatheter sizes should be favored when possible.


Assuntos
Cateteres , Infarto da Artéria Cerebral Média/cirurgia , Modelos Anatômicos , Neuronavegação/métodos , Trombose/cirurgia , Cateterismo/instrumentação , Cateterismo/métodos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/métodos , Humanos , Neuronavegação/instrumentação , Trombectomia/instrumentação , Trombectomia/métodos
15.
Bosn J Basic Med Sci ; 19(1): 24-30, 2019 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-30589401

RESUMO

High-field intraoperative MRI (iMRI) systems provide excellent imaging quality and are used for resection control and update of image guidance systems in a number of centers. A ceiling-mounted intraoperative MRI system has several advantages compared to a conventional iMRI system. In this article, we report on first clinical experience with using such a state-of-the-art, the 1.5T iMRI system, in Europe. A total of 50 consecutive patients with intracranial tumors and vascular lesions were operated in the iMRI unit. We analyzed the patients' data, surgery preparation times, intraoperative scans, surgical time, and radicality of tumor removal. Patients' mean age was 46 years (range 8 to 77 years) and the median surgical procedure time was 5 hours (range 1 to 11 hours). The lesions included 6 low-grade gliomas, 8 grade III astrocytomas, 10 glioblastomas, 7 metastases, 7 pituitary adenomas, 2 cavernomas, 2 lymphomas, 1 cortical dysplasia, 3 aneurysms, 1 arterio-venous malformation and 1 extracranial-intracranial bypass, 1 clival chordoma, and 1 Chiari malformation. In the surgical treatment of tumor lesions, intraoperative imaging depicted tumor remnant in 29.7% of the cases, which led to a change in the intraoperative strategy. The mobile 1.5T iMRI system proved to be safe and allowed an optimal workflow in the iMRI unit. Due to the fact that the MRI scanner is moved into the operating room only for imaging, the working environment is comparable to a regular operating room.


Assuntos
Imagem por Ressonância Magnética/instrumentação , Monitorização Intraoperatória , Procedimentos Neurocirúrgicos/instrumentação , Cirurgia Assistida por Computador/instrumentação , Adolescente , Adulto , Idoso , Anestesia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Criança , Europa (Continente) , Feminino , Glioma/cirurgia , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Neuronavegação/instrumentação , Salas Cirúrgicas/organização & administração , Estudos Retrospectivos , Adulto Jovem
16.
World Neurosurg ; 118: e422-e427, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30257298

RESUMO

OBJECTIVE: Neuronavigation systems are routinely used during neurosurgical procedures. Currently, new imaging technologies are emerging, such as virtual, augmented, and mixed reality. With mixed-reality devices, the user can analyze and interact with the real environment using virtual objects. The aim of this prospective pilot study was to offer a proof of concept by testing the clinical feasibility and accuracy of a wearable mixed-reality device (Hololens) for preoperative neurosurgical planning. METHODS: In patients with an indication for brain tumor surgery, preoperative planning of tumor localization with the Hololens was compared with standard neuronavigation in the operating room. Magnetic resonance imaging-based 3-dimensional holograms of the patient's head and tumor were created and projected on the physical patient's head using the Hololens. The 2-dimensional projection of the tumor borders as perceived by the neurosurgeon on the skin of the patient's head was outlined both with the Hololens and neuronavigation. Accuracy of the Hololens localization was assessed using neuronavigation as the gold standard. RESULTS: Twenty-five patients were included in this study. Holograms were successfully created in all cases. In 9 patients tumor localization with the Hololens did not differ from the standard neuronavigation system and the overall median difference was 0.4 cm (interquartile range 0-0.8). CONCLUSIONS: This prospective clinical study offers a proof of concept of the clinical feasibility of the Hololens for brain tumor surgery planning in the operating room, with quantitative outcome measures. Further development is needed to improve the accuracy of this wearable mixed-reality device.


Assuntos
Neoplasias Encefálicas/cirurgia , Imagem Tridimensional/métodos , Neuronavegação/métodos , Cirurgia Assistida por Computador/métodos , Realidade Virtual , Dispositivos Eletrônicos Vestíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico por imagem , Estudos de Viabilidade , Feminino , Humanos , Imagem Tridimensional/instrumentação , Masculino , Pessoa de Meia-Idade , Neuronavegação/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Procedimentos Neurocirúrgicos/métodos , Projetos Piloto , Cuidados Pré-Operatórios/instrumentação , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Cirurgia Assistida por Computador/instrumentação , Adulto Jovem
17.
J Neural Eng ; 15(6): 066003, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30124202

RESUMO

OBJECTIVE: Stereotactic frame systems are the gold-standard for stereotactic surgeries, such as implantation of deep brain stimulation (DBS) devices for treatment of medically resistant neurologic and psychiatric disorders. However, frame-based systems require that the patient is awake with a stereotactic frame affixed to their head for the duration of the surgical planning and implantation of the DBS electrodes. While frameless systems are increasingly available, a reusable re-attachable frame system provides unique benefits. As such, we created a novel reusable MRI-compatible stereotactic frame system that maintains clinical accuracy through the detachment and reattachment of its stereotactic devices used for MRI-guided neuronavigation. APPROACH: We designed a reusable arc-centered frame system that includes MRI-compatible anchoring skull screws for detachment and re-attachment of its stereotactic devices. We validated the stability and accuracy of our system through phantom, in vivo mock-human porcine DBS-model and human cadaver testing. MAIN RESULTS: Phantom testing achieved a root mean square error (RMSE) of 0.94 ± 0.23 mm between the ground truth and the frame-targeted coordinates; and achieved an RMSE of 1.11 ± 0.40 mm and 1.33 ± 0.38 mm between the ground truth and the CT- and MRI-targeted coordinates, respectively. In vivo and cadaver testing achieved a combined 3D Euclidean localization error of 1.85 ± 0.36 mm (p < 0.03) between the pre-operative MRI-guided placement and the post-operative CT-guided confirmation of the DBS electrode. SIGNIFICANCE: Our system demonstrated consistent clinical accuracy that is comparable to conventional frame and frameless stereotactic systems. Our frame system is the first to demonstrate accurate relocation of stereotactic frame devices during in vivo MRI-guided DBS surgical procedures. As such, this reusable and re-attachable MRI-compatible system is expected to enable more complex, chronic neuromodulation experiments, and lead to a clinically available re-attachable frame that is expected to decrease patient discomfort and costs of DBS surgery.


Assuntos
Imagem por Ressonância Magnética/instrumentação , Neuronavegação/instrumentação , Técnicas Estereotáxicas/instrumentação , Animais , Parafusos Ósseos , Cadáver , Estimulação Encefálica Profunda , Reutilização de Equipamento , Humanos , Imagem por Ressonância Magnética/métodos , Neuronavegação/métodos , Imagens de Fantasmas , Reprodutibilidade dos Testes , Cirurgia Assistida por Computador/instrumentação , Suínos , Tomografia Computadorizada por Raios X
18.
World Neurosurg ; 120: 190-199, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30165208

RESUMO

The fundamental role of technological instruments in contemporary Neurosurgery is undisputed, and intraoperative magnetic resonance imaging (MRI) represents one of the best examples. The use of a modern high-field magnet and the possibility to match the MRI with an operative microscope and an integrated neuronavigation system has led to successful results in the surgical treatment of different diseases. At our institute, we have performed surgery routinely with the aid of intraoperative MRI over the last 15 years. The aim of this article is to report our experience in the management of neurovascular lesions with the use of this device. We experienced that intraoperative MRI enhanced the surgical experience, leading to an improved postoperative outcome in the treatment of different lesions, such as arteriovenous malformations, dural arteriovenous fistulas, intracranial cavernous angiomas, and intracranial aneurysms. There are several advantages provided by the use of intraoperative MRI. The use of intraoperative MRI coupled with the planning station and the neuronavigation system allows one to obtain preoperative 3-dimensional reconstructions of the vessels, which aids the definition of the anatomy of each neurovascular lesion. Furthermore, the possibility performing an intraoperative scan allows a comparison with preoperative images and, subsequently, the updating of the surgical strategy. Intraoperative diffusion-weighted imaging can detect possible territorial ischemia that would be amenable to intensive treatment. Although increased costs, increased surgical times, increased anesthesiology times, and the possible increased risk of surgical infection may represent some major limitation, the use of intraoperative MRI-equipped operative theaters with integrated neuronavigation systems can prove extremely helpful in the management of neurovascular conditions.


Assuntos
Malformações Arteriovenosas Intracranianas/cirurgia , Imagem por Ressonância Magnética , Neuronavegação/instrumentação , Salas Cirúrgicas , Equipamentos Cirúrgicos , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/cirurgia , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/cirurgia , Imagem de Difusão por Ressonância Magnética/instrumentação , Desenho de Equipamento , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Hospitais Universitários , Humanos , Imagem Tridimensional/instrumentação , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Período Intraoperatório
19.
Neurosurg Focus ; 45(VideoSuppl1): V5, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29963915

RESUMO

A 63-year-old man presented with progressive lower-extremity paresis over the previous 3 months. He had been unable to support himself to ambulate over the previous 3 weeks. The patient was found to have metastatic renal cell carcinoma to T11. He underwent robotic assisted percutaneous placement of T9-L1 pedicle screws and open T11 laminectomy/debulking of tumor. This approach allowed for decreased blood loss without the need for preoperative embolization. After decompression and placement of the hardware, the patient regained the ability to ambulate on his own. The video can be found here: https://youtu.be/BTFQezhZlB4 .


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Neuronavegação/métodos , Parafusos Pediculares , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Coluna Vertebral/cirurgia , Carcinoma de Células Renais/diagnóstico por imagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neuronavegação/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/secundário , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia
20.
Neurourol Urodyn ; 37(8): 2776-2781, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30054931

RESUMO

OBJECTIVE: To evaluate the feasibility and safety of an individualized and reassemblable three-dimensional (3D) printing navigation template for making accurate punctures during sacral neuromodulation (SNM). METHODS: From July 2016 to July 2017, 24 patients undergoing SNM were enrolled. Conventional X-ray guidance was used in the control group, which included 14 patients, while the 3D printing template was used in the experimental group, which included 10 patients. The number of punctures, the average puncture time, the exposure to X-ray, the adjustment time during the operation and the testing of the SNM device, the infection and haemorrhage rate, and the implantable pulse generator (IPG) implantation rates were compared between the two groups. RESULTS: In total, 24 patients successfully underwent stage I. When comparing the control group and the experimental group, the number of punctures were 9.6 ± 7.7 and 1.5 ± 0.7, respectively; the average puncture times were 35.4 ± 14.6 and 4.1 ± 2.2 min, respectively; and the X-ray exposure levels were 8.37 ± 4.83 mAs and 2.34 ± 0.54 mAs, respectively. No postoperative complications were reported in either group. The IPG implantation rates were not different between the two groups. CONCLUSION: The 3D printing template for SNM can help us to perform accurate and quick punctures into the target sacral foramina, reduce X-ray exposure, and shorten the operation time. For patients with obesity, sacral variation, sacral bone fractures or losses and for patients who are unable to tolerate the prone position during operation, use of the 3D printing template is recommended.


Assuntos
Terapia por Estimulação Elétrica/métodos , Sintomas do Trato Urinário Inferior/terapia , Impressão Tridimensional , Punções , Sacro/diagnóstico por imagem , Adulto , Idoso , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuronavegação/instrumentação , Neuronavegação/métodos , Punções/instrumentação , Punções/métodos , Punções/normas , Adulto Jovem
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