Articles: neuronavigation.
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Major steps in the evolution of advanced neurosurgical techniques include microneurosurgery, neuroendoscopy and its minimally invasive variations, neuronavigation, and advanced intraoperative imaging. With traditional neuroendoscopic techniques (e.g., freehand endoscopy or the use of mechanical arms), definitive controlled movement of the endoscope within the brain depends on the experience and skill of the individual neurosurgeon. ⋯ The use of robotic technology for neuroendoscopic procedures is a major advance for controlled movement of the endoscope within the cranium. The start-up procedure and calibration of the robot are still time-consuming, but the actual operation time is comparable to that of freehand neuroendoscopic procedures. Steering of the endoscope is facilitated, and the precision of the endoscopic movements is noteworthy.
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Journal of neurosurgery · Nov 2002
Intracranial navigation by using low-field intraoperative magnetic resonance imaging: preliminary experience.
Intracranial navigation by using intraoperative magnetic resonance (iMR) imaging allows the surgeon to reassess anatomical relationships in near-real time during brain tumor surgery. The authors report their initial experience with a novel neuronavigation system coupled to a low-field iMR imaging system. ⋯ Intraoperative MR image-based neuronavigation is feasible when using the Odin PoleStar N-10 system for tumor resections that require multiple other surgical adjuncts including awake procedures, cortical mapping, monitoring of somatosensory evoked potentials, or electrocorticography. Use of the system for brain biopsies offers the opportunity of immediate verification of the needle tip location. Standard neurosurgical drills, microscopes, and other equipment can be used safely in conjunction with this iMR imaging system.
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Neuronavigation provides intraoperative orientation to the surgeon, helps in planning a precise surgical approach to the targetted lesion and defines the surrounding neurovascular structures. Incorporation of the functional data provided by functional MRI and magnetoencephalography (MEG) with neuronavigation helps to avoid the eloquent areas of the brain during surgery. An intraoperative MRI enables radical resection of the lesions, the possibility of immediate control for tumor remnants and updates of neuronavigation with intraoperative images to compensate for brain shift. ⋯ The simultaneous use of intraoperative MRI to look for the remaining tumor was done in 159 patients and the update of navigational data was carried out in 17 patients. The mean system accuracy obtained by using both the fiducial registration as well as anatomical landmark-surface fitting computer algorithm was 1.81 mm. This study reviews the relative merits and demerits of the pointer and microscope based navigational systems and also highlights the role of functional brain mapping and intraoperative MRI, when integrated with neuronavigation, in the surgical decision-making to offer the chances of more radical resections with minimal morbidity.
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To assess the role that neuronavigation plays in assisting endoscopic transsphenoidal reoperations for recurrent pituitary adenomas. ⋯ Neuronavigation can be applied during endonasal transsphenoidal endoscopic surgery and requires a minimal amount of time. It makes reoperation easier, faster, and probably safer.
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Several models for the application of intra-operative magnetic resonance imaging (IMRI) have recently been reported, most of them unique. Two fundamental issues need to be addressed: optimal use of the scanner to ensure a wide base for research, development and clinical application, and an organisational model that facilitates such use. ⋯ Intra-operative MRI is an imaging tool that can be useful especially in the context of neuronavigation. A scanner that can be turned off during surgery is particularly appropriate for neurosurgery. The concept of joint use of such facilities with other clinicians is mutually worthwhile.