Optimized Intraoperative Imaging for Stereotactic Planning with a Multiaxial Robotic C-arm System: Technical Note and Case Series

2021 ◽  
Author(s):  
Frederik Enders ◽  
Andreas Rothfuss ◽  
Stefanie Brehmer ◽  
Jan Stallkamp ◽  
Dirk Michael Schulte ◽  
...  
Keyword(s):  
Intraoperative Imaging ◽  
Case Series ◽  
Brain Biopsy ◽  
Cranial Computed Tomography ◽  
Preoperative Imaging ◽  
Control Group ◽  
Procedure Time ◽  
Stereotactic Brain Biopsy ◽  
Artis Zeego ◽  
Total Procedure

Abstract Background The preoperative preparation of the planning dataset for frame-based stereotactic brain biopsy is often associated with logistical effort and burden on the patient. Intraoperative imaging modalities need to be investigated to overcome these limitations. Objective The objective of the study was to develop and apply a new method for the intraoperative acquisition of the planning dataset with the multiaxial robotic C-arm system Artis zeego. Methods An indication-customized dose-reduced protocol for Artis zeego was developed and implemented into the workflow. A sample of 14 patients who had undergone intraoperative imaging with Artis zeego was analyzed. A sample of 10 patients with conventional preoperative imaging by cranial computed tomography (CT) was used as a control group. Outcomes were compared with regard to target deviation, diagnostic value of the biopsies, complications, and procedure time. Results In all patients, a suitable intraoperative planning dataset could be acquired with Artis zeego. Total procedure time was shorter for the Artis zeego group (p = 0.01), whereas time in the operating room area was longer in the Artis zeego group (p = 0.04). Biopsy results were diagnostic in 12 patients (86%) in the Artis zeego group and in 8 patients (80%) in the control group. There were no significant differences in target size, trajectory length, or target deviation. Conclusion Intraoperative imaging for frame-based stereotactic brain biopsy with Artis zeego is an easy and feasible method. Accuracy is comparable to conventional CT, whereas radiation exposure could be additionally reduced. It allows a significant reduction of the total procedure length and improves the comfort for the patient and staff.

Stereotactic brain biopsy: an audit of sampling reliabilityin a clinical case series

2006 ◽  
Vol 20 (4) ◽  
pp. 222-226 ◽  
Author(s):  
N. Shastri-Hurst ◽  
M Tsegaye ◽  
D. K. Robson ◽  
J. S. Lowe ◽  
D. C. Macarthur
Keyword(s):  
Clinical Case ◽  
Case Series ◽  
Brain Biopsy ◽  
Stereotactic Brain Biopsy

scholarly journals The diagnostic accuracy and era for improvement for frameless stereotactic brain biopsy: a series of 109 procedures and a systemic review

2021 ◽  
Author(s):  
Zhexi He ◽  
Xian Lun Zhu ◽  
Tat Ming Danny Chan ◽  
Chi Yan Tom Cheung ◽  
Ho-Keung Ng ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Case Series ◽  
Brain Biopsy ◽  
Systemic Review ◽  
Safe Procedure ◽  
Stereotactic Brain Biopsy ◽  
Registration Errors ◽  
Negative Results ◽  
Operative Planning ◽  
Conclusive Diagnosis

Abstract PurposeTo evaluate the diagnostic accuracy of frameless stereotactic brain biopsy and review the era for improvement.MethodsThis is a prospectively collected cohort study from 2007 to 2020. We reviewed patients who received frameless stereotactic brain biopsy in Prince of Wales Hospital and evaluated the diagnostic accuracy of the frameless stereotactic brain biopsy procedures. The biopsy result was classified into conclusive, inconclusive or negative, based on the pathological, radiological and clinical diagnosis concordance. For inconclusive or negative results, we further evaluated the pre-operative planning and post-operative imaging to review if further improvement could be made. The complication rate of symptomatic hemorrhage and mortality rate was also analyzed.ResultsThere were 106 patients with 109 biopsy procedures performed from 2007 to 2020. The conclusive diagnosis was reached in 103 (94.5%) procedures. The inconclusive diagnosis was noted in four (3.7%) procedures and negative diagnosis was yielded in two (1.9%) procedures. Symptomatic hemorrhage was noted in one patient (0.9%). There was no mortality case (0.0%) in our case series. The registration errors occurred in three cases (2.8%), sampling of the non-representative part of the lesion occurred in two cases (1.8%), and one biopsy (0.9%) for lymphoma was negative after the commencement of steroids. Systemic review showed that the diagnostic accuracy under the structurally defined diagnosis criteria was comparable with published literatures in recent ten years.ConclusionThe stereotactic biopsy is a safe procedure with high diagnostic accuracy only if meticulous pre-operative planning and careful intra-operative registration is performed. The common pitfalls precluding a conclusive diagnosis are errors during registration and non-representative biopsy sites.

Brain shift during bur hole–based procedures using interventional MRI

2014 ◽  
Vol 121 (1) ◽  
pp. 149-160 ◽  
Author(s):  
Michael E. Ivan ◽  
Jay Yarlagadda ◽  
Akriti P. Saxena ◽  
Alastair J. Martin ◽  
Philip A. Starr ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Brain Biopsy ◽  
Brain Structures ◽  
Interventional Mri ◽  
Preoperative Imaging ◽  
Brain Shift ◽  
Stereotactic Brain Biopsy ◽  
Electrode Implantation ◽  
The Brain ◽  
Deep Brain

Object Brain shift during minimally invasive, bur hole–based procedures such as deep brain stimulation (DBS) electrode implantation and stereotactic brain biopsy is not well characterized or understood. We examine shift in various regions of the brain during a novel paradigm of DBS electrode implantation using interventional imaging throughout the procedure with high-field interventional MRI. Methods Serial MR images were obtained and analyzed using a 1.5-T magnet prior to, during, and after the placement of DBS electrodes via frontal bur holes in 44 procedures. Three-dimensional coordinates in MR space of unique superficial and deep brain structures were recorded, and the magnitude, direction, and rate of shift were calculated. Measurements were recorded to the nearest 0.1 mm. Results Shift ranged from 0.0 to 10.1 mm throughout all structures in the brain. The greatest shift was seen in the frontal lobe, followed by the temporal and occipital lobes. Shift was also observed in deep structures such as the anterior and posterior commissures and basal ganglia; shift in the pallidum and subthalamic region ipsilateral to the bur hole averaged 0.6 mm, with 9% of patients having over 2 mm of shift in deep brain structures. Small amounts of shift were observed during all procedures; however, the initial degree of shift and its direction were unpredictable. Conclusions Brain shift is continual and unpredictable and can render traditional stereotactic targeting based on preoperative imaging inaccurate even in deep brain structures such as those used for DBS.

scholarly journals Evaluation of Dry Eye after Implantable Collamer Lens Surgery

2020 ◽  
Author(s):  
Haiting Chen ◽  
Xueyan Feng ◽  
Guangzeng Niu ◽  
Yuxiang Fan
Keyword(s):  
Dry Eye ◽  
Ocular Surface ◽  
Case Series ◽  
Meibomian Gland ◽  
Quality Score ◽  
Control Group ◽  
Ocular Surface Disease Index ◽  
Implantable Collamer Lens ◽  
Lens Surgery ◽  
Breakup Time

<b><i>Objectives:</i></b> To evaluate dry eye (DE) and associated meibomian gland dysfunction parameters after Implantable Collamer Lens (ICL) surgery. <b><i>Methods:</i></b> This is a prospective observational case series. Patients who underwent ICL implantation without previous ocular diseases or ophthalmic treatments were enrolled. Their Ocular Surface Disease Index (OSDI), noninvasive breakup time (NIBUT), meibography, slit-lamp examination of the lid margin, corneal fluorescein staining (CFS), and Schirmer test I were examined preoperatively and at 1 and 3 months postoperatively. <b><i>Results:</i></b> A total of 117 eyes of 60 patients were enrolled, and 107 eyes completed 3-month follow-up period. OSDI, lid marginal abnormality, and meibomian gland (MG) secretion, and meibum quality score were significantly higher at 1 month postoperatively and recovered partially at 3 months after surgeries, while NIBUT was significantly decreased all the time. Patients with previous DE symptoms (OSDI score ≥12) showed not only lower Schirmer and TBUT values but also higher CFS, lid margin score, MG loss, MG secretion, and meibum quality scores compared with those in the control group after operations. Low Schirmer, NIBUT values, and high meibum quality score were determined as risk factors for DE symptoms after ICL surgery. <b><i>Conclusions:</i></b> ICL implantation has a bad influence on the ocular surface and MG functions. The influence may be more obvious in patients with existing DE.

scholarly journals Autologous Platelet-Rich Fibrin (PRF) as an Adjunct in the Management of Osteoradionecrosis and Medication-Related Osteonecrosis of Jaws. Case Series in A Single Centre

2021 ◽  
Vol 11 (8) ◽  
pp. 3365
Author(s):  
Benjie Law ◽  
Hui Yuh Soh ◽  
Syed Nabil ◽  
Rama Krsna Rajandram ◽  
Abd Jabar Nazimi ◽  
...  
Keyword(s):  
Case Series ◽  
Cost Effective ◽  
Control Group ◽  
Platelet Rich Fibrin ◽  
Tissue Healing ◽  
Number Of Patients ◽  
Short Period ◽  
Oral And Maxillofacial Region ◽  
Surgical Adjunct ◽  
Autologous Platelet

Osteoradionecrosis (ORN) of the jaws and medication-related osteonecrosis of the jaws (MRONJ) are uncommon but serious diseases affecting the oral and maxillofacial region with clinically similar appearance but distinct pathophysiology. Management of ORN and MRONJ is inherently challenging and the treatment outcomes are unpredictable. The use of autologous platelet concentrates (APCs) to promote hard and soft tissue healing is well described in the literature, and the efficacy of leucocyte and platelet-rich fibrin (L-PRF) has been well documented in a number of clinical studies. The aim of this study was to present our treatment strategy and the outcomes of incorporating L-PRF as a surgical adjunct in management of ORN and MRONJ in our centre. Methods: eight cases of ORN and MRONJ were treated with a combination of sequestrectomy and L-PRF as a surgical adjunct. Results: the overall success was 87.5%. Using L-PRF as an adjunct, we were able to predictably manage ORN and MRONJ without causing significant morbidity. Conclusion: our experience shows that L-PRF may be used as a valuable and cost-effective adjunct to surgical management of ORN and MRONJ. However, due to a limited number of patients, and a short period of review, the true effectiveness of the method is yet to be demonstrated in a longer follow-up study including a greater number of patients, besides the inclusion of a control group.

scholarly journals Enhancing Patient Experience in Office-Based Laryngology Procedures With Passive Virtual Reality

OTO Open ◽  
2021 ◽  
Vol 5 (1) ◽  
pp. 2473974X2097502
Author(s):  
Joseph Chang ◽  
Sen Ninan ◽  
Katherine Liu ◽  
Alfred Marc Iloreta ◽  
Diana Kirke ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Local Anesthesia ◽  
Controlled Trial ◽  
Care Center ◽  
Tertiary Care ◽  
Depression Scale ◽  
Control Group ◽  
Procedure Time ◽  
Pain Scores ◽  
Distress Scale

Objectives Virtual reality (VR) has been used as nonpharmacologic anxiolysis benefiting patients undergoing office-based procedures. There is little research on VR use in laryngology. This study aims to determine the efficacy of VR as anxiolysis for patients undergoing in-office laryngotracheal procedures. Study Design Randomized controlled trial. Setting Tertiary care center. Methods Adult patients undergoing office-based larynx and trachea injections, biopsy, or laser ablation were recruited and randomized to receive standard care with local anesthesia only or local anesthesia with adjunctive VR. Primary end point was procedural anxiety measured by the Subjective Units of Distress Scale (SUDS). Subjective pain, measured using a visual analog scale, satisfaction scores, and procedure time, and baseline anxiety, measured using the Hospital Anxiety and Depression Scale (HADS), were also collected. Results Eight patients were randomized to the control group and 8 to the VR group. SUDS scores were lower in the VR group than in the control group with mean values of 26.25 and 53.13, respectively ( P = .037). Baseline HADS scores did not differ between groups. There were no statistically significant differences in pain, satisfaction, or procedure time. Average satisfaction scores in VR and control groups were 6.44 and 6.25, respectively ( P = .770). Average pain scores were 3.53 and 2.64, respectively ( P = .434). Conclusion This pilot study suggests that VR distraction may be used as an adjunctive measure to decrease patient anxiety during office-based laryngology procedures. Procedures performed using standard local anesthesia resulted in low pain scores and high satisfaction scores even without adjunctive VR analgesia. Level of Evidence 1

scholarly journals A Decade of Marketing Authorization Applications of Anticancer Drugs in the European Union: An Analysis of Procedural Timelines

2021 ◽  
Author(s):  
Marjolein Garsen ◽  
Maaike Steenhof ◽  
Alex Zwiers
Keyword(s):  
Anticancer Drugs ◽  
Marketing Authorization ◽  
European Medicines Agency ◽  
Company Size ◽  
Scientific Advice ◽  
The European Union ◽  
Small Companies ◽  
Procedure Time ◽  
Total Procedure Time ◽  
Total Procedure

Abstract Background Cancer is a serious global health problem and a major cause of death. The European Medicines Agency (EMA) has established several regulatory initiatives to expedite the development and authorization of drugs to ensure timely access of patients. In this study, we analyzed the procedural timelines of marketing authorization applications for anticancer drugs in the EU, with a specific focus to special regulatory programs, scientific advice and company size. Methods Anticancer drugs that received an opinion from the EMA between January 2010 and December 2019 were included in the study. Public assessment reports were used to obtain publicly available information of the drugs. Results We identified 96 applications for new anticancer drugs. 34 applications were granted access to at least one expedited program offered by the EMA. Total procedure time was reduced from average 370 to 200–215 days when accelerated assessment was granted. Granting of a conditional marketing authorization or an orphan designation, as well as having scientific advice, only mildly affected total procedure time. Average total procedure time of small companies was much longer compared with medium-sized and large companies (483 versus 356 days), which was caused by an increased clock stop time. Conclusion Total procedure time for anticancer is mainly affected by the granting of accelerated assessment, which reduced the total procedure time, and company size, where total procedure time is much longer for small companies. Small companies are advised to have, and especially adhere to scientific advice to reduce procedure time and increase the chance of success.

A Semi-Autonomous Stereotactic Brain Biopsy Robot With Enhanced Safety

2020 ◽  
Vol 5 (2) ◽  
pp. 1405-1412
Author(s):  
Minxin Ye ◽  
Weibing Li ◽  
Danny Tat Ming Chan ◽  
Philip Wai Yan Chiu ◽  
Zheng Li
Keyword(s):  
Brain Biopsy ◽  
Stereotactic Brain Biopsy

scholarly journals 1H-MRS-Guided Stereotactic Brain Biopsy

2012 ◽  
Vol 90 (1) ◽  
pp. 63-65 ◽  
Author(s):  
Mikhail Chernov ◽  
Yoshihiro Muragaki ◽  
Takaomi Taira ◽  
Hiroshi Iseki
Keyword(s):  
Brain Biopsy ◽  
Stereotactic Brain Biopsy

Safety of a Protective Funnel in Primary Breast Augmentation: A Retrospective Analysis of 380 Multicenter Cases in the United States

2021 ◽  
Author(s):  
Aldo Lombardo ◽  
Alfred R Antonetti ◽  
Joel Studin ◽  
Frank Stile ◽  
Dudley Giles ◽  
...  
Keyword(s):  
Breast Augmentation ◽  
Case Series ◽  
The United States ◽  
Future Research ◽  
Control Group ◽  
Superficial Infection ◽  
Class 1 ◽  
Median Volume ◽  
Implant Size ◽  
Potential Risk Factors

Abstract Background Protective funnels devices are commonly used to deliver implants in primary breast augmentation (BA) yet there is a paucity of evidence-based data describing their safety in the literature. Objectives The purpose of the study was to assess the safety of protective funnels in primary BA within the first 30-days postoperatively. Methods This multi-center, Level 3 study retrospectively reviewed the surgical records of 380 consecutive patients (760 breasts) who underwent primary BA by nine board-certified plastic surgeons using the iNPLANT Funnel (Proximate Concepts LLC, Allendale, NJ, USA) for implant delivery between November 2019 and December 2020. Data was collected pertaining to demographics, implant information, surgery details, and postoperative complications. Results The mean patient age was 33 years and 76% patients had a BMI &lt; 25. Of this cohort, 11.4% were smokers, 0.8% had diabetes, and 83% were ASA class 1. All patients received smooth implants with a median volume of 375cc. A total of 8 (2.1%) complications were reported including: 3 hematomas (0.79%), 1 seroma (0.26%) and 1 superficial infection (0.26%). No patient required explantation. We identified ASA class, BMI, surgery duration, and implant size as potential risk factors. Conclusions The data suggest that use of protective funnels, such as the iNPLANT Funnel, in primary BA are a safe option when used according to the manufacturer’s IFU. Its use led to a low infection rate (0.26%) and a complication rate (2.1%) consistent with the average reported in the literature (2%-2.5%). 1 Implications for clinical practice are encouraging and future research will include a prospective analysis with a larger case series and potentially a control group.

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