scholarly journals Brain shift modeling for use in neurosurgery

1998 ◽  
pp. 641-649 ◽  
Author(s):  
Oskar Škrinjar ◽  
Dennis Spencer ◽  
James Duncan
Keyword(s):  
Brain Shift

scholarly journals A Simple Method to Avoid Brain Shift during Neuronavigation: Technical Note

2020 ◽  
Author(s):  
Jair Leopoldo Raso
Keyword(s):  
Dura Mater ◽  
Brain Area ◽  
Conventional Technique ◽  
Technical Note ◽  
Cortical Surface ◽  
Brain Shift ◽  
Simple Method ◽  
Cortex Area ◽  
Neuronavigation System ◽  
The Brain

Abstract Introduction The precise identification of anatomical structures and lesions in the brain is the main objective of neuronavigation systems. Brain shift, displacement of the brain after opening the cisterns and draining cerebrospinal fluid, is one of the limitations of such systems. Objective To describe a simple method to avoid brain shift in craniotomies for subcortical lesions. Method We used the surgical technique hereby described in five patients with subcortical neoplasms. We performed the neuronavigation-guided craniotomies with the conventional technique. After opening the dura and exposing the cortical surface, we placed two or three arachnoid anchoring sutures to the dura mater, close to the edges of the exposed cortical surface. We placed these anchoring sutures under microscopy, using a 6–0 mononylon wire. With this technique, the cortex surface was kept close to the dura mater, minimizing its displacement during the approach to the subcortical lesion. In these five cases we operated, the cortical surface remained close to the dura, anchored by the arachnoid sutures. All the lesions were located with a good correlation between the handpiece tip inserted in the desired brain area and the display on the navigation system. Conclusion Arachnoid anchoring sutures to the dura mater on the edges of the cortex area exposed by craniotomy constitute a simple method to minimize brain displacement (brain-shift) in craniotomies for subcortical injuries, optimizing the use of the neuronavigation system.

Brain shift: an error factor during implantation of deep brain stimulation electrodes

2007 ◽  
Vol 107 (5) ◽  
pp. 989-997 ◽  
Author(s):  
Yasushi Miyagi ◽  
Fumio Shima ◽  
Tomio Sasaki
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Brain Shift ◽  
Mr Images ◽  
Implanted Electrodes ◽  
Error Factor ◽  
Bilateral Surgery ◽  
Second Procedure ◽  
The Brain ◽  
Deep Brain

Object The goal of this study was to focus on the tendency of brain shift during stereotactic neurosurgery and the shift's impact on the unilateral and bilateral implantation of electrodes for deep brain stimulation (DBS). Methods Eight unilateral and 10 bilateral DBS electrodes at 10 nuclei ventrales intermedii and 18 subthalamic nuclei were implanted in patients at Kaizuka Hospital with the aid of magnetic resonance (MR) imaging–guided and microelectrode-guided methods. Brain shift was assessed as changes in the 3D coordinates of the anterior and posterior commissures (AC and PC) with MR images before and immediately after the implantation surgery. The positions of the implanted electrodes, based on the midcommissural point and AC–PC line, were measured both on x-ray films (virtual position) during surgery and the postoperative MR images (actual position) obtained on the 7th day postoperatively. Results Contralateral and posterior shift of the AC and PC were the characteristics of unilateral and bilateral procedures, respectively. The authors suggest the following. 1) The first unilateral procedure elicits a unilateral air invasion, resulting in a contralateral brain shift. 2) During the second procedure in the bilateral surgery, the contralateral shift is reset to the midline and, at the same time, the anteroposterior support by the contralateral hemisphere against gravity is lost due to a bilateral air invasion, resulting in a significant posterior (caudal) shift. Conclusions To note the tendency of the brain to shift is very important for accurate implantation of a DBS electrode or high frequency thermocoagulation, as well as for the prediction of therapeutic and adverse effects of stereotactic surgery.

Deep Bypasses to the Distal Posterior Circulation

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. 92-101 ◽  
Author(s):  
Zsolt Zador ◽  
Daniel C. Lu ◽  
Christine M. Arnold ◽  
Michael T. Lawton
Keyword(s):  
Temporal Lobe ◽  
Artery Bypass ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Brain Shift ◽  
Morphometric Measurements ◽  
Subtemporal Approach ◽  
Cerebellar Artery

Abstract OBJECTIVE The subtemporal approach for a superficial temporal artery–to–superior cerebellar artery bypass requires significant superior retraction that can injure the temporal lobe, compromise veins, and cause edema postoperatively. In contrast, the pretemporal approach requires posterolateral retraction that seems to be less injurious to the temporal lobe and better tolerated clinically. We hypothesized that the pretemporal approach provides ample exposure, more gentle retraction, and better clinical results than the subtemporal approach. METHODS Standard orbitozygomatic-pterional and subtemporal approaches were performed on both sides of 4 formalin-fixed cadaver heads for morphometric measurements. Temporal lobe retraction was quantified for each approach in terms of brain shift and retraction pressure by using both sides of 3 fresh, unfixed cadaver heads. Similar morphometric measurements were made in 14 patients in whom bypasses to the distal posterior circulation were performed. The effect of temporal lobe retraction was assessed with edema volumes on postoperative computed tomography scans. RESULTS In cadaver heads and in patients, the pretemporal approach optimized exposure of the P2A segment of the posterior cerebral artery (PCA) and the subtemporal approach optimized exposure of the lateral pontomesencephalic segment of the superior cerebellar artery (SCA). Working depths and lengths of exposed artery were similar with these 2 approaches, but the PCA was a larger recipient than the SCA. Brain shift was 42% less with pretemporal than with subtemporal retraction, and retraction pressure was 43% less with pretemporal than with subtemporal retraction. The volume of temporal lobe edema was 56% less in patients with bypasses performed with the pretemporal approach as compared with the subtemporal approach. CONCLUSION Pretemporal exposure of the PCA is equivalent to subtemporal exposure of the SCA, but the pretemporal approach is facilitated by a larger recipient artery. Posterolateral temporal lobe retraction associated with the pretemporal approach is gentler than superior retraction with the subtemporal approach. These results validate our preference for the pretemporal approach over the subtemporal approach when performing deep bypasses to the posterior circulation.

scholarly journals Neurosurgery and brain shift: review of the state of the art and main contributions of robotics

TecnoLógicas ◽  
2017 ◽  
Vol 20 (40) ◽  
pp. 125-138
Author(s):  
Karin Correa-Arana ◽  
Oscar A. Vivas-Albán ◽  
José M. Sabater-Navarro
Keyword(s):  
Brain Tumor ◽  
State Of The Art ◽  
Image Guided Surgery ◽  
Medical Procedures ◽  
Brain Shift ◽  
Future Perspectives ◽  
Guided Surgery ◽  
Image Guided ◽  
Neuronavigation System ◽  
Minimal Invasion

This paper presents a review about neurosurgery, robotic assistants in this type of procedure, and the approach to the problem of brain tissue displacement, including techniques for obtaining medical images. It is especially focused on the phenomenon of brain displacement, commonly known as brain shift, which causes a loss of reference between the preoperative images and the volumes to be treated during image-guided surgery. Hypothetically, with brain shift prediction and correction for the neuronavigation system, minimal invasion trajectories could be planned and shortened. This would reduce damage to functional tissues and possibly lower the morbidity and mortality in delicate and demanding medical procedures such as the removal of a brain tumor. This paper also mentions other issues associated with neurosurgery and shows the way robotized systems have helped solve these problems. Finally, it highlights the future perspectives of neurosurgery, a branch of medicine that seeks to treat the ailments of the main organ of the human body from the perspective of many disciplines.

scholarly journals Visualization of lenticulostriate arteries during insular low-grade glioma surgeries by navigated 3D ultrasound power Doppler: technical note

2016 ◽  
Vol 125 (4) ◽  
pp. 1016-1023 ◽  
Author(s):  
Andrej Šteňo ◽  
Michaela Jezberová ◽  
Vladimír Hollý ◽  
Gabriela Timárová ◽  
Juraj Šteňo
Keyword(s):  
Power Doppler ◽  
Residual Tumor ◽  
3D Ultrasound ◽  
Technical Note ◽  
Minimal Amount ◽  
Low Grade ◽  
Brain Shift ◽  
Lenticulostriate Arteries ◽  
Grade Ii ◽  
Intraoperative Localization

OBJECTIVE Resection of insular gliomas is challenging. In cases of intraoperative injury to the lenticulostriate arteries (LSAs), the usual result is a dense hemiplegia. LSAs are usually localized just behind the medial tumor border but they can also be encased by the tumor. Thus, exact localization of these perforators is important. However, intraoperative localization of LSAs using conventional neuronavigation can be difficult due to brain shift. In this paper, the authors present a novel method of intraoperative LSA visualization by navigated 3D ultrasound (3DUS) power Doppler. This technique enables almost real-time imaging of LSAs and evaluation of their shift during insular tumor resections. METHODS Six patients harboring insular Grade II gliomas were consecutively operated on at the Department of Neurosurgery in Bratislava using visualization of LSAs by navigated 3DUS power Doppler. In all cases, the 3DUS data were repeatedly updated to compensate for the brain shift and display the actual position of LSAs and residual tumor. RESULTS Successful visualization of LSAs was achieved in all cases. During all surgeries, the distance between the bottom of the resection cavity and LSAs could be accurately evaluated; in all tumors the resection approached the LSAs and only a minimal amount of tissue covering these perforators was intentionally left in place to avoid injury to them. CONCLUSIONS Visualization of LSAs by navigated 3DUS power Doppler is a useful tool that may help to prevent injury of LSAs during removal of insular low-grade gliomas. However, reliability of this method has to be carefully evaluated in further studies.

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