Automated neurosurgical stereotactic planning for intraoperative use: a comprehensive review of the literature and perspectives.

The creation of intracranial stereotactic trajectories, from entry point to target point, is still mostly done manually by the neurosurgeon. The development of automated stereotactic planning tools has been described in the literature. This systematic review aims to assess the effectiveness of stereotactic planning procedure automation and develop tools for patients undergoing neurosurgical stereotactic procedures. PubMed/MEDLINE, EMBASE, Google Scholar, CINAHL, PsycINFO, and Cochrane Register of Controlled Trials databases were searched from inception to September 1, 2019, at the exception of Google Scholar (from 1 January 2010 to September 1, 2019) in French and English. Eligible studies included all studies proposing automated stereotactic planning. A total of 1543 studies were screened. Forty-two studies were included in the systematic review, including 18 (42.9%) conference papers. The surgical procedures planned automatically were mainly deep brain stimulation (n = 14, 33.3%), stereoelectroencephalography (n = 12, 28.6%), and not specified (n = 10, 23.8%). The most frequently used surgical constraints to plan the trajectory were blood vessels (n = 32, 76.2%), cerebral sulci (n = 27, 64.3%), and cerebral ventricles (n = 23, 54.8%). The distance from blood vessels ranged from 1.96 to 4.78 mm for manual trajectories and from 2.47 to 7.0 mm for automated trajectories. At least one neurosurgeon was involved in 36 studies (85.7%). The automated stereotactic trajectory was preferred in 75.4% of the studied cases (range 30-92.9). Only 3 (7.1%) studies were multicentric. No study reported prospective use of the planning software. Stereotactic planning automation is a promising tool to provide valuable stereotactic trajectories for clinical applications.

Fundamentals in Artificial Intelligence for Vascular Surgeons.

Artificial intelligence (AI) corresponds to a broad discipline that aims to design systems, which display properties of human intelligence. While it has led to many advances and applications in daily life, its introduction in medicine is still in its infancy. AI has created interesting perspectives for medical research and clinical practice but has been sometimes associated with hype leading to a misunderstanding of its real capabilities. Here, we aim to introduce the fundamental notions of AI and to bring an overview of its potential applications for medical and surgical practice. In the limelight of current knowledge, limits and challenges to face as well as future directions are discussed.

Wearable Augmented Reality Platform for Aiding Complex 3D Trajectory Tracing.

Augmented reality (AR) Head-Mounted Displays (HMDs) are emerging as the most efficient output medium to support manual tasks performed under direct vision. Despite that, technological and human-factor limitations still hinder their routine use for aiding high-precision manual tasks in the peripersonal space. To overcome such limitations, in this work, we show the results of a user study aimed to validate qualitatively and quantitatively a recently developed AR platform specifically conceived for guiding complex 3D trajectory tracing tasks. The AR platform comprises a new-concept AR video see-through (VST) HMD and a dedicated software framework for the effective deployment of the AR application. In the experiments, the subjects were asked to perform 3D trajectory tracing tasks on 3D-printed replica of planar structures or more elaborated bony anatomies. The accuracy of the trajectories traced by the subjects was evaluated by using templates designed ad hoc to match the surface of the phantoms. The quantitative results suggest that the AR platform could be used to guide high-precision tasks: on average more than 94% of the traced trajectories stayed within an error margin lower than 1 mm. The results confirm that the proposed AR platform will boost the profitable adoption of AR HMDs to guide high precision manual tasks in the peripersonal space.

New perspectives on surgical accuracy analysis of image-guided bone tumour resection surgery.

PURPOSE: Image-guided bone tumour resection surgery has been proved in previous literatures to be more accurate than those conventional freehand ones (p < 0.001). However, in this kind of surgery, there are still many procedures depending on manual operations, which will inevitably introduce surgical errors into the surgery. In particular, the negative surgical errors (i.e., errors toward tumour) would increase the risk of tumor recurrence and metastasis. Thus, the first purpose of this study was to evaluate whether the negative surgical errors of image-guided bone tumour resection surgery were statistically significantly great, the second purpose is to evaluate whether the negative surgical errors of image-guided long-bone tumour resection surgery were statistically equivalent to those of pelvis surgery, and the last purpose is to recommend a solution for suppressing these errors when using a navigation system. METHODS: Negative surgical errors of 24 osteotomies in ten pelvis tumour resection operations and 16 osteotomies in ten long-bone surgeries under the image guidance of a navigation system were statistically evaluated and compared with - 2.0 mm. The equivalence of negative surgical errors of pelvis group and those of long-bone group was statistically tested. To suppress these negative surgical errors when using a navigation system, we recommend, based on the obtained statistics, to increase the margins between cut planes and tumour boundary during pre-operatively planning cut planes, by adding an extra margin with the empirical safe margin according to the absolute lower bound of 95% CI of negative surgical errors. RESULTS: Negative surgical errors of the pelvis group and the long-bone group were both significantly less than - 2.0 mm (p < 0.001), but not statistically equivalent (Rg > 1 mm). 95% CI of negative surgical errors were from - 3.95 to - 3.27 mm for the pelvis group, and from - 2.69 to - 2.34 mm for the long-bone group. So, the extra margin added for image-guided pelvis tumour resection surgery should be set as 3.95 mm, and the extra margin added for image-guided long-bone surgery should be set as 2.69 mm. CONCLUSION: The negative surgical errors of image-guided bone resection surgery were statistically significantly less than - 2.0 mm (p < 0.001), thus these errors cannot be safely ignored. Moreover, the negative surgical errors of the pelvis group were not equivalent to those of the long-bone group (Rg > 1.0 mm), thus the solution for image-guided pelvis tumour resection surgery and that for image-guided long-bone tumour resection surgery should be separately determined. In order to suppress these negative surgical errors when using a navigation system, we recommend to add extra 3.95 mm margin with the empirical safe margin for image-guided pelvis tumour resection surgery and to add extra 2.69 mm margin for image-guided long-bone tumour resection surgery during pre-operatively planning cut planes.

Evaluating the impact of image guidance in the surgical setting: a systematic review.

BACKGROUND: Image guidance has been clinically available for over a period of 20 years. Although research increasingly has a translational emphasis, overall the clinical uptake of image guidance systems in surgery remains low. The objective of this review was to establish the metrics used to report on the impact of surgical image guidance systems used in a clinical setting. METHODS: A systematic review of the literature was carried out on all relevant publications between January 2000 and April 2016. Ovid MEDLINE and Embase databases were searched using a title strategy. Reported outcome metrics were grouped into clinically relevant domains and subsequent sub-categories for analysis. RESULTS: In total, 232 publications were eligible for inclusion. Analysis showed that clinical outcomes and system interaction were consistently reported. However, metrics focusing on surgeon, patient and economic impact were reported less often. No increase in the quality of reporting was observed during the study time period, associated with study design, or when the clinical setting involved a surgical specialty that had been using image guidance for longer. CONCLUSIONS: Publications reporting on the clinical use of image guidance systems are evaluating traditional surgical outcomes and neglecting important human and economic factors, which are pertinent to the uptake, diffusion and sustainability of image-guided surgery. A framework is proposed to assist researchers in providing comprehensive evaluation metrics, which should also be considered in the design phase. Use of these would help demonstrate the impact in the clinical setting leading to increased clinical integration of image guidance systems.

Recent Trends, Technical Concepts and Components of Computer-Assisted Orthopedic Surgery Systems: A Comprehensive Review.

Computer-assisted orthopedic surgery (CAOS) systems have become one of the most important and challenging types of system in clinical orthopedics, as they enable precise treatment of musculoskeletal diseases, employing modern clinical navigation systems and surgical tools. This paper brings a comprehensive review of recent trends and possibilities of CAOS systems. There are three types of the surgical planning systems, including: systems based on the volumetric images (computer tomography (CT), magnetic resonance imaging (MRI) or ultrasound images), further systems utilize either 2D or 3D fluoroscopic images, and the last one utilizes the kinetic information about the joints and morphological information about the target bones. This complex review is focused on three fundamental aspects of CAOS systems: their essential components, types of CAOS systems, and mechanical tools used in CAOS systems. In this review, we also outline the possibilities for using ultrasound computer-assisted orthopedic surgery (UCAOS) systems as an alternative to conventionally used CAOS systems.

The New Frontier: A Review of Augmented Reality and Virtual Reality in Plastic Surgery.

Mixed reality, a blending of the physical and digital worlds, can enhance the surgical experience, leading to greater precision, efficiency, and improved outcomes. Various studies across different disciplines have reported encouraging results using mixed reality technologies, such as augmented and virtual reality. To provide a better understanding of the applications and limitations of this technology in plastic surgery, we performed a systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The initial query of the National Center for Biotechnology Information database yielded 2544 results, and only 46 articles met our inclusion criteria. The majority of studies were in the field of craniofacial surgery, and uses of mixed reality included preoperative planning, intraoperative guides, and education of surgical trainees. A deeper understanding of mixed reality technologies may promote its integration and also help inspire new and creative applications in healthcare.

Computer-assisted surgery: virtual- and augmented-reality displays for navigation during urological interventions.

PURPOSE OF REVIEW: To provide an overview of the developments made for virtual- and augmented-reality navigation procedures in urological interventions/surgery. RECENT FINDINGS: Navigation efforts have demonstrated potential in the field of urology by supporting guidance for various disorders. The navigation approaches differ between the individual indications, but seem interchangeable to a certain extent. An increasing number of pre- and intra-operative imaging modalities has been used to create detailed surgical roadmaps, namely: (cone-beam) computed tomography, MRI, ultrasound, and single-photon emission computed tomography. Registration of these surgical roadmaps with the real-life surgical view has occurred in different forms (e.g. electromagnetic, mechanical, vision, or near-infrared optical-based), whereby the combination of approaches was suggested to provide superior outcome. Soft-tissue deformations demand the use of confirmatory interventional (imaging) modalities. This has resulted in the introduction of new intraoperative modalities such as drop-in US, transurethral US, (drop-in) gamma probes and fluorescence cameras. These noninvasive modalities provide an alternative to invasive technologies that expose the patients to X-ray doses. Whereas some reports have indicated navigation setups provide equal or better results than conventional approaches, most trials have been performed in relatively small patient groups and clear follow-up data are missing. SUMMARY: The reported computer-assisted surgery research concepts provide a glimpse in to the future application of navigation technologies in the field of urology.

Therapeutic Intervention in Musculoskeletal Radiology: Current Practice and Future Directions.

Over the last several decades, the volume and range of therapeutic musculoskeletal (MSK) interventions that radiologists can offer their patients has dramatically increased. With new materials and improving imaging modalities, as well as significant investment in research, the field of MSK interventional radiologic intervention will likely continue to expand. In this article, we summarize the range of interventions currently available to the MSK radiologist. We also seek to explore new and emerging techniques that may become commonplace in the near future while considering the challenges that may lie ahead in the field of MSK radiology.

The Role of Three-Dimensional Printing in Contemporary Vascular and Endovascular Surgery: A Systematic Review.

BACKGROUND: Three-dimensional (3D) printing, also known as rapid prototyping or additive manufacturing, is a novel adjunct in the medical field. The aim of this systematic review is to evaluate the role of 3D printing technology in the field of contemporary vascular surgery in terms of its technical aspect, practicability, and clinical outcome. METHODS: A systematic search of literatures published from January 1, 1980 to July 15, 2017 was identified from the EMBASE, MEDLINE, and Cochrane library database with reference to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. The predefined selection inclusion criterion was clinical application of 3D printing technology in vascular surgery of large and small vessel pathology. RESULTS: Forty-two articles were included in this systematic review, including 2 retrospective cohorts and 1 prospective case control study. 3D printing was mostly applied to abdominal aortic aneurysm (n = 20) and thoracic aorta pathology (n = 8), other vessels included celiac, splenic, carotid, subclavian, femoral artery, and portal vein (n = 10). The most commonly quoted materials were acrylonitrile-butadiene-styrene (n = 2), polylactic acid (n = 4), polyurethane resin (n = 3) and nylon (n = 3). The cost per replica ranged from USD $4-2,360. Cost for a commercial printer was around USD $2,210-50,000. CONCLUSION: 3D printing was recognized and gradually incorporated as a useful adjunct in the field of vascular and endovascular surgery. The production of an accurate anatomic patient-specific replica was shown to bring significant impact in patient management in terms of anatomic understanding, procedural planning, and intraoperative navigation, education, and academic research as well as patient communication. Further analysis on cost-effectiveness was indicated to guide decisions on applicability of such promising technology on a routine basis.

The emerging role of transcranial magnetic resonance imaging-guided focused ultrasound in functional neurosurgery.

To review the emerging role of transcranial MR-guided focused ultrasound as a treatment and research modality for functional neurological disorders, we summarize recent clinical and preclinical studies. Clinical trials have investigated the safety and efficacy of thermal lesions created by transcranial, high-intensity focused ultrasound. Preclinical work has additionally investigated the ability to disrupt the blood-brain barrier and to produce reversible neuromodulation with focused ultrasound utilizing lower intensities. We discuss ongoing trials and future avenues of investigation. © 2016 International Parkinson and Movement Disorder Society.

A quick glance at selected topics in this issue.

A quick glance at selected topics in this issue" aims to highlight selected articles and provide a quick review to the readers.

Augmented Reality in Neurosurgery: A Review of Current Concepts and Emerging Applications.

Augmented reality (AR) superimposes computer-generated virtual objects onto the user's view of the real world. Among medical disciplines, neurosurgery has long been at the forefront of image-guided surgery, and it continues to push the frontiers of AR technology in the operating room. In this systematic review, we explore the history of AR in neurosurgery and examine the literature on current neurosurgical applications of AR. Significant challenges to surgical AR exist, including compounded sources of registration error, impaired depth perception, visual and tactile temporal asynchrony, and operator inattentional blindness. Nevertheless, the ability to accurately display multiple three-dimensional datasets congruently over the area where they are most useful, coupled with future advances in imaging, registration, display technology, and robotic actuation, portend a promising role for AR in the neurosurgical operating room.

[New strategies and technologies for ablation of atrial fibrillation : Where do we go?] / Neue Strategien und Technologien für die Ablation von Vorhofflimmern : "Where do we go?".

Catheter-based ablation is an established treatment option for patients with symptomatic atrial fibrillation (AF). Pulmonary vein isolation is the established cornerstone of all ablation strategies. However, the rate of electrical reconduction of previously isolated pulmonary veins is high and associated with recurrence of AF. Novel and innovative mapping and ablation systems are being developed or are under clinical evaluation aiming for higher durability of pulmonary vein isolation. Additional ablation strategies for patients with recurrence of AF despite persistent isolation of the pulmonary veins are under evaluation. These ablation strategies include ablation of complex fractionated atrial electrograms, linear lesions, rotors or drivers, fibrotic areas or ablation of extrapulmonary triggers. The true clinical benefit of these additional ablation strategies can only be assessed if the pulmonary veins are persistently isolated.

[Glioblastoma, innovations in surgery]. / Glioblastome, des innovations en chirurgie.

One of the innovative principles in glioblastoma surgery consists in making the tumour fluorescent in order for it to be more easily visualised during the procedure. 5-aminolevulinic acid (5-ALA) undergoes an enzyme transformation, turning into another molecule, protoporphyrine IX (PPIX) whose property is fluorescence. It emits red light when it is stimulated by blue light.

MRI methods for the evaluation of high intensity focused ultrasound tumor treatment: Current status and future needs.

Thermal ablation with high intensity focused ultrasound (HIFU) is an emerging noninvasive technique for the treatment of solid tumors. HIFU treatment of malignant tumors requires accurate treatment planning, monitoring and evaluation, which can be facilitated by performing the procedure in an MR-guided HIFU system. The MR-based evaluation of HIFU treatment is most often restricted to contrast-enhanced T1 -weighted imaging, while it has been shown that the non-perfused volume may not reflect the extent of nonviable tumor tissue after HIFU treatment. There are multiple studies in which more advanced MRI methods were assessed for their suitability for the evaluation of HIFU treatment. While several of these methods seem promising regarding their sensitivity to HIFU-induced tissue changes, there is still ample room for improvement of MRI protocols for HIFU treatment evaluation. In this review article, we describe the major acute and delayed effects of HIFU treatment. For each effect, the MRI methods that have been-or could be-used to detect the associated tissue changes are described. In addition, the potential value of multiparametric MRI for the evaluation of HIFU treatment is discussed. The review ends with a discussion on future directions for the MRI-based evaluation of HIFU treatment.

Proceedings of the American Association of Oral and Maxillofacial Surgeons 2015 Research Summit.

The Fifth Biennial Research Summit of the American Association of Oral and Maxillofacial Surgeons and its Committee on Research Planning and Technology Assessment was held in Rosemont, Illinois on May 6 and 7, 2015. The goal of the symposium is to provide a forum for the most recent clinical and scientific advances to be brought to the specialty. The proceedings of the events of that summit are presented in this report.

[Evolution of total knee arthroplasty. From robotics and navigation to patient-specific instruments]. / Entwicklung der Knieendoprothetik. Von der Robotik über die Navigation zu den patientenspezifischen Instrumenten.

In this article the evolution beginning with the robotics of total knee arthroplasty to CT-based and kinematic navigation and patient-specific instruments is described. Thereby it is pointed out that in the early 1990s, CT imaging solely for the planning of a knee endoprosthesis was considered as obsolete radiation exposure and this led to the widespread development of kinematical systems.Also a patient specific planning tool based on CAD built acryl harz blocs existed at the time. There is an ongoing process of implanting total knee arthroplasties in a more exact position. Nowadays the new evolution of soft tissue balancing by using a kinematic alignment has put these efforts into perspective.

[The evolution of 3D imaging in orthopedic trauma care. German version]. / Entwicklung der 3­D-Bildgebung in der Versorgung orthopädischer Verletzungen.

Three-dimensional (3D) imaging can enhance trauma care by allowing better evaluation of bony detail and implant position compared to conventional fluoroscopy or x­ray. Intraoperative 3D imaging further improves this evaluation by allowing any necessary revisions to be made in the operating room prior to the patient emerging from anesthesia. This revision, if necessary, better achieves the surgical goals and alleviates the stressful situation of obtaining postoperative 3D imaging, where the benefit of revision must be balanced against the cost and risk of returning to the operating room. Improved image volume, resolution, and software capability have allowed surgeons to obtain high quality, wide field views of bony anatomy that can include the uninjured side as a comparison. In this paper, the evolution of intraoperative 3D imaging over the past 25 years is discussed.