scholarly journals Rediscovery of the transcerebellar approach: improving the risk-benefit ratio in robot-assisted brainstem biopsies

2022 ◽  
Vol 52 (1) ◽  
pp. E12
Keyword(s):  
Diagnostic Yield ◽  
Robotic Systems ◽  
Target Point ◽  
Special Focus ◽  
Robot Assisted ◽  
Surgical Morbidity ◽  
Benefit Ratio ◽  
Mortality And Morbidity ◽  
Standard Quality ◽  
Cerebellar Peduncle

OBJECTIVE Conventional frame-based stereotaxy through a transfrontal approach (TFA) is the gold standard in brainstem biopsies. Because of the high surgical morbidity and limited impact on therapy, brainstem biopsies are controversial. The introduction of robot-assisted stereotaxy potentially improves the risk-benefit ratio by simplifying a transcerebellar approach (TCA). The aim of this single-center cohort study was to evaluate the risk-benefit ratio of transcerebellar brainstem biopsies performed by 2 different robotic systems. In addition to standard quality indicators, a special focus was set on trajectory selection for reducing surgical morbidity. METHODS This study included 25 pediatric (n = 7) and adult (n = 18) patients who underwent 26 robot-assisted biopsies via a TCA. The diagnostic yield, complication rate, trajectory characteristics (i.e., length, anatomical entry, and target-point location), and skin-to-skin (STS) time were evaluated. Transcerebellar and hypothetical transfrontal trajectories were reconstructed and transferred into a common MR space for further comparison with anatomical atlases. RESULTS Robot-assisted, transcerebellar biopsies demonstrated a high diagnostic yield (96.2%) while exerting no surgical mortality and no permanent morbidity in both pediatric and adult patients. Only 3.8% of cases involved a transient neurological deterioration. Transcerebellar trajectories had a length of 48.4 ± 7.3 mm using a wide stereotactic corridor via crus I or II of the cerebellum and the middle cerebellar peduncle. The mean STS time was 49.5 ± 23.7 minutes and differed significantly between the robotic systems (p = 0.017). The TFA was characterized by longer trajectories (107.4 ± 11.8 mm, p < 0.001) and affected multiple eloquent structures. Transfrontal target points were located significantly more medial (−3.4 ± 7.2 mm, p = 0.042) and anterior (−3.9 ± 8.4 mm, p = 0.048) in comparison with the transcerebellar trajectories. CONCLUSIONS Robot-assisted, transcerebellar stereotaxy can improve the risk-benefit ratio of brainstem biopsies by avoiding the restrictions of a TFA and conventional frame-based stereotaxy. Profound registration and anatomical-functional trajectory selection were essential to reduce mortality and morbidity.

Accuracy of robot-assisted versus optical frameless navigated stereoelectroencephalography electrode placement in children

2019 ◽  
Vol 23 (3) ◽  
pp. 297-302 ◽  
Author(s):  
Julia D. Sharma ◽  
Kiran K. Seunarine ◽  
Muhammad Zubair Tahir ◽  
Martin M. Tisdall
Keyword(s):  
Soft Tissue ◽  
Entry Point ◽  
Electrode Placement ◽  
Target Point ◽  
Localization Error ◽  
Bone Thickness ◽  
Tissue Thickness ◽  
Robot Assisted ◽  
Soft Tissue Thickness ◽  
Safety Margins

OBJECTIVEThe aim of this study was to compare the accuracy of optical frameless neuronavigation (ON) and robot-assisted (RA) stereoelectroencephalography (SEEG) electrode placement in children, and to identify factors that might increase the risk of misplacement.METHODSThe authors undertook a retrospective review of all children who underwent SEEG at their institution. Twenty children were identified who underwent stereotactic placement of a total of 218 electrodes. Six procedures were performed using ON and 14 were placed using a robotic assistant. Placement error was calculated at cortical entry and at the target by calculating the Euclidean distance between the electrode and the planned cortical entry and target points. The Mann-Whitney U-test was used to compare the results for ON and RA placement accuracy. For each electrode placed using robotic assistance, extracranial soft-tissue thickness, bone thickness, and intracranial length were measured. Entry angle of electrode to bone was calculated using stereotactic coordinates. A stepwise linear regression model was used to test for variables that significantly influenced placement error.RESULTSBetween 8 and 17 electrodes (median 10 electrodes) were placed per patient. Median target point localization error was 4.5 mm (interquartile range [IQR] 2.8–6.1 mm) for ON and 1.07 mm (IQR 0.71–1.59) for RA placement. Median entry point localization error was 5.5 mm (IQR 4.0–6.4) for ON and 0.71 mm (IQR 0.47–1.03) for RA placement. The difference in accuracy between Stealth-guided (ON) and RA placement was highly significant for both cortical entry point and target (p < 0.0001 for both). Increased soft-tissue thickness and intracranial length reduced accuracy at the target. Increased soft-tissue thickness, bone thickness, and younger age reduced accuracy at entry. There were no complications.CONCLUSIONSRA stereotactic electrode placement is highly accurate and is significantly more accurate than ON. Larger safety margins away from vascular structures should be used when placing deep electrodes in young children and for trajectories that pass through thicker soft tissues such as the temporal region.

scholarly journals Stereoelectroencephalography

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 353-366 ◽  
Author(s):  
Francesco Cardinale ◽  
Massimo Cossu ◽  
Laura Castana ◽  
Giuseppe Casaceli ◽  
Marco Paolo Schiariti ◽  
...  
Keyword(s):  
Interquartile Range ◽  
Entry Point ◽  
Target Point ◽  
Epileptogenic Zone ◽  
Localization Error ◽  
Drug Resistant ◽  
Robot Assisted ◽  
Data Set ◽  
Essential Information

Abstract BACKGROUND: Stereoelectroencephalography (SEEG) methodology, originally developed by Talairach and Bancaud, is progressively gaining popularity for the presurgical invasive evaluation of drug-resistant epilepsies. OBJECTIVE: To describe recent SEEG methodological implementations carried out in our center, to evaluate safety, and to analyze in vivo application accuracy in a consecutive series of 500 procedures with a total of 6496 implanted electrodes. METHODS: Four hundred nineteen procedures were performed with the traditional 2-step surgical workflow, which was modified for the subsequent 81 procedures. The new workflow entailed acquisition of brain 3-dimensional angiography and magnetic resonance imaging in frameless and markerless conditions, advanced multimodal planning, and robot-assisted implantation. Quantitative analysis for in vivo entry point and target point localization error was performed on a sub-data set of 118 procedures (1567 electrodes). RESULTS: The methodology allowed successful implantation in all cases. Major complication rate was 12 of 500 (2.4%), including 1 death for indirect morbidity. Median entry point localization error was 1.43 mm (interquartile range, 0.91-2.21 mm) with the traditional workflow and 0.78 mm (interquartile range, 0.49-1.08 mm) with the new one (P &lt; 2.2 × 10−16). Median target point localization errors were 2.69 mm (interquartile range, 1.89-3.67 mm) and 1.77 mm (interquartile range, 1.25-2.51 mm; P &lt; 2.2 × 10−16), respectively. CONCLUSION: SEEG is a safe and accurate procedure for the invasive assessment of the epileptogenic zone. Traditional Talairach methodology, implemented by multimodal planning and robot-assisted surgery, allows direct electrical recording from superficial and deep-seated brain structures, providing essential information in the most complex cases of drug-resistant epilepsy.

scholarly journals Trends in Hysterectomy for Genital Prolapse: Rural Experience

2013 ◽  
Vol 7 ◽  
pp. CMRH.S10804 ◽  
Author(s):  
Shakuntala Chhabra ◽  
Manjiri Ramteke ◽  
Sonali Mehta ◽  
Nisha Bhole ◽  
Yojna Yadav
Keyword(s):  
Coming Out ◽  
Vaginal Hysterectomy ◽  
Preoperative Evaluation ◽  
Genital Prolapse ◽  
Uterovaginal Prolapse ◽  
Preoperative Treatment ◽  
Genital Tract Infection ◽  
Surgical Morbidity ◽  
Mortality And Morbidity ◽  
Abnormal Vaginal Bleeding

The present study was conducted to investigate the trends of vaginal hysterectomy for genital prolapse in last 20 years by analyzing case records of affected women. During the analysis period, 4831 women underwent hysterectomy; records of 4223 (87.5%) were available. Of these, 911 (21.6%), 2.7% of 34,080 gynecological admissions, had vaginal hysterectomy for genital prolapse (study subjects). Eighty percent women who had vaginal hysterectomy for genital prolapse were over 40 years of age; however, most of these women had had the disorder for years before they presented. Only 4 (0.4%) women had not given birth, 874 (96%) women had had two or more births, and 383 (42%) had had 5 or more births. Having given birth was the major factor responsible for genital prolapse. In all, 94.2% of women presented with something coming out of the vagina.” Some women presented with abnormal vaginal bleeding or pain in abdomen as the chief complaint although they had had uterovaginal prolapse for years. There was no mortality and morbidity decreased over the years. There has been no change in the rate of vaginal hysterectomy for genital prolapse over the years. Surgical morbidity decreased trend, possibly because of the preoperative, intraoperative, and postoperative precautions taken, especially preoperative treatment of urinary and genital tract infection. Attempts need to be made to have safe births and a healthy life style so as to prevent genital prolapse and in case it occurs, therapy to prevent progression so that major interventions like hysterectomy are averted. Meticulous preoperative evaluation and planned therapy help in reducing surgical morbidity, if surgery becomes essential.

scholarly journals Frameless robotic stereotactic biopsies: a consecutive series of 100 cases

2015 ◽  
Vol 122 (2) ◽  
pp. 342-352 ◽  
Author(s):  
Michel Lefranc ◽  
Cyrille Capel ◽  
Anne-Sophie Pruvot-Occean ◽  
Anthony Fichten ◽  
Christine Desenclos ◽  
...  
Keyword(s):  
Stereotactic Biopsy ◽  
Clinical Symptoms ◽  
Diagnostic Yield ◽  
Ct Scanning ◽  
Fiducial Marker ◽  
Surface Registration ◽  
Histological Diagnosis ◽  
Consecutive Series ◽  
Mortality And Morbidity ◽  
Stereotactic Biopsies

OBJECT Stereotactic biopsy procedures are an everyday part of neurosurgery. The procedure provides an accurate histological diagnosis with the least possible morbidity. Robotic stereotactic biopsy needs to be an accurate, safe, frameless, and rapid technique. This article reports the clinical results of a series of 100 frameless robotic biopsies using a Medtech ROSA device. METHODS The authors retrospectively analyzed their first 100 frameless stereotactic biopsies performed with the robotic ROSA device: 84 biopsies were performed by frameless robotic surface registration, 7 were performed by robotic bone fiducial marker registration, and 9 were performed by scalp fiducial marker registration. Intraoperative flat-panel CT scanning was performed concomitantly in 25 cases. The operative details of the robotic biopsies, the diagnostic yield, and mortality and morbidity data observed in this series are reported. RESULTS A histological diagnosis was established in 97 patients. No deaths or permanent morbidity related to surgery were observed. Six patients experienced transient neurological worsening. Six cases of bleeding within the lesion or along the biopsy trajectory were observed on postoperative CT scans but were associated with transient clinical symptoms in only 2 cases. Stereotactic surgery was performed with patients in the supine position in 93 cases and in the prone position in 7 cases. The use of fiducial markers was reserved for posterior fossa biopsy via a transcerebellar approach, via an occipital approach, or for pediatric biopsy. CONCLUSIONS ROSA frameless stereotactic biopsies appear to be accurate and safe robotized frameless procedures.

scholarly journals Robotic Systems for Prostate Cancer Brachytherapy (Robot-Assisted Systems)

2015 ◽  
Vol 8 (29) ◽  
Author(s):  
N. A. Gryaznov ◽  
K. Y. Senchik ◽  
Velichko O. Valerievna ◽  
A. N. Korenkov ◽  
G. S. Kireeva
Keyword(s):  
Prostate Cancer ◽  
Robotic Systems ◽  
Robot Assisted

Oxford Handbook of Respiratory Nursing

2021 ◽  
Author(s):  
Terry Robinson ◽  
Jane Scullion
Keyword(s):  
Full Range ◽  
Tertiary Care ◽  
Special Focus ◽  
Nursing Management ◽  
Care Needs ◽  
Mortality And Morbidity ◽  
Psychosocial Concerns ◽  
Significant Burden ◽  
Respiratory Conditions

Respiratory disease is one of the leading causes of both mortality and morbidity, causing a significant burden on healthcare resources, the economy, and on individual patients and their carers. Respiratory conditions are managed in many different settings, from home and residential care through the full range of primary to tertiary care. The multifaceted nature of both diseases affecting respiration and the care options is comprehensively covered in this second edition of the Oxford Handbook of Respiratory Nursing. Offering a systematic description of the main respiratory diseases found in adults, the Handbook covers the assessment, diagnosis, and nursing management of each condition. With a special focus on the role of the multidisciplinary team in meeting the multiple care needs of respiratory patients, the Handbook covers both physical and psychosocial concerns, and both pharmacological and non-pharmacological therapies.

Postresuscitation Care after Out-of-hospital Cardiac Arrest

2019 ◽  
Vol 131 (1) ◽  
pp. 186-208 ◽  
Author(s):  
Hans Kirkegaard ◽  
Fabio Silvio Taccone ◽  
Markus Skrifvars ◽  
Eldar Søreide
Keyword(s):  
Cardiac Arrest ◽  
Best Practice ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Special Focus ◽  
International Guidelines ◽  
Mortality And Morbidity ◽  
Postresuscitation Care ◽  
Neuroprotective Strategy ◽  
Hospital Cardiac Arrest

Abstract Out-of-hospital cardiac arrest is a major cause of mortality and morbidity worldwide. With the introduction of targeted temperature management more than a decade ago, postresuscitation care has attracted increased attention. In the present review, we discuss best practice hospital management of unconscious out-of-hospital cardiac arrest patients with a special focus on targeted temperature management. What is termed post–cardiac arrest syndrome strikes all organs and mandates access to specialized intensive care. All patients need a secured airway, and most patients need hemodynamic support with fluids and/or vasopressors. Furthermore, immediate coronary angiography and percutaneous coronary intervention, when indicated, has become an essential part of the postresuscitation treatment. Targeted temperature management with controlled sedation and mechanical ventilation is the most important neuroprotective strategy to take. Targeted temperature management should be initiated as quickly as possible, and according to international guidelines, it should be maintained at 32° to 36°C for at least 24 h, whereas rewarming should not increase more than 0.5°C per hour. However, uncertainty remains regarding targeted temperature management components, warranting further research into the optimal cooling rate, target temperature, duration of cooling, and the rewarming rate. Moreover, targeted temperature management is linked to some adverse effects. The risk of infection and bleeding is moderately increased, as is the risk of hypokalemia and magnesemia. Circulation needs to be monitored invasively and any deviances corrected in a timely fashion. Outcome prediction in the individual patient is challenging, and a self-fulfilling prophecy poses a real threat to early prognostication based on clinical assessment alone. Therefore, delayed and multimodal prognostication is now considered a key element of postresuscitation care. Finally, modern postresuscitation care can produce good outcomes in the majority of patients but requires major diagnostic and therapeutic resources and specific training. Hence, recent international guidelines strongly recommend the implementation of regional prehospital resuscitation systems with integrated and specialized cardiac arrest centers.

scholarly journals Motion and Trajectory Constraints Control Modeling for Flexible Surgical Robotic Systems

Micromachines ◽  
2020 ◽  
Vol 11 (4) ◽  
pp. 386
Author(s):  
Olatunji Mumini Omisore ◽  
Shipeng Han ◽  
Yousef Al-Handarish ◽  
Wenjing Du ◽  
Wenke Duan ◽  
...  
Keyword(s):  
Real Time ◽  
A Priori ◽  
Tumor Resection ◽  
Computational Effort ◽  
Robotic Systems ◽  
Kinematics And Dynamics ◽  
Target Point ◽  
Real Time Control ◽  
Control Models ◽  
Constraints Model

Success of the da Vinci surgical robot in the last decade has motivated the development of flexible access robots to assist clinical experts during single-port interventions of core intrabody organs. Prototypes of flexible robots have been proposed to enhance surgical tasks, such as suturing, tumor resection, and radiosurgery in human abdominal areas; nonetheless, precise constraint control models are still needed for flexible pathway navigation. In this paper, the design of a flexible snake-like robot is presented, along with the constraints model that was proposed for kinematics and dynamics control, motion trajectory planning, and obstacle avoidance during motion. Simulation of the robot and implementation of the proposed control models were done in Matlab. Several points on different circular paths were used for evaluation, and the results obtained show the model had a mean kinematic error of 0.37 ± 0.36 mm with very fast kinematics and dynamics resolution times. Furthermore, the robot’s movement was geometrically and parametrically continuous for three different trajectory cases on a circular pathway. In addition, procedures for dynamic constraint and obstacle collision detection were also proposed and validated. In the latter, a collision-avoidance scheme was kept optimal by keeping a safe distance between the robot’s links and obstacles in the workspace. Analyses of the results showed the control system was optimal in determining the necessary joint angles to reach a given target point, and motion profiles with a smooth trajectory was guaranteed, while collision with obstacles were detected a priori and avoided in close to real-time. Furthermore, the complexity and computational effort of the algorithmic models were negligibly small. Thus, the model can be used to enhance the real-time control of flexible robotic systems.

scholarly journals Accuracy of SEEG Electrodes Implanted in Lateral Position Versus Supine Position

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Caio M Matias ◽  
Sandeep Kandregula ◽  
Chengyuan Wu ◽  
Ashwini D Sharan
Keyword(s):  
Supine Position ◽  
Three Dimensional ◽  
Major Complication ◽  
Lateral Position ◽  
Entry Point ◽  
Target Point ◽  
Robot Assisted ◽  
Dimensional Error ◽  
Electrode Implantation ◽  
Position Group

Abstract INTRODUCTION Accuracy during SEEG implantations is critical as several electrodes will cross narrow corridors between cerebral blood vessels. Previous studies have compared the accuracy of different techniques such as frame-based, frameless, and robot-assisted implantations and overall SEEG has been reported to be quite safe, with a major complication incidence of less than 1%. Typically, the supine position is utilized for implantation; however, the lateral position may be more comfortable and ergonomic for trajectories with a posterior entry point (eg, posterior approach to the insula). To our knowledge, this is the first study to compare the accuracy of SEEG electrodes implanted in supine position vs lateral position. METHODS About 22 patients who underwent SEEG electrode implantation using Leksell frame fixation and Neuromate robot were included in this study and clustered according to the supine (n = 11) or lateral (n = 11) position. A total of 284 electrodes (Supine: n = 139; Lateral: n = 145) were analyzed. Postoperative Oarm images were co-registered with the preoperative plan on Voxim software. Cartesian coordinates of the entry point (EP) and target point (TP) were obtained from the planned trajectory and the implanted electrode. Three-dimensional error (Euclidian distance) and radial error for EP and TP were calculated. Wilcoxon rank sum test was used to compare lateral versus supine group. RESULTS Radial errors were similar between both groups. EP three-dimensional error was higher in the lateral position group (1.3 mm vs 1.7 mm, P = .004), whereas TP three-dimensional error was higher in the supine position group (2.9 mm vs 1.8 mm, P < .001). CONCLUSION SEEG electrode implantation using frame-based fixation and robot-assisted technique in the lateral position has similar accuracy compared to implantation in the supine position.

Frameless Stereotactic Brain Biopsies: Comparison of Minimally Invasive Robot-Guided and Manual Arm-Based Technique

2020 ◽  
Vol 19 (3) ◽  
pp. 292-301
Author(s):  
Georgi Minchev ◽  
Gernot Kronreif ◽  
Wolfgang Ptacek ◽  
Joachim Kettenbach ◽  
Alexander Micko ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Diagnostic Yield ◽  
Operating Time ◽  
Point Group ◽  
Skin Incision ◽  
Target Point ◽  
Incision Length ◽  
Biopsy Technique ◽  
Lower Accuracy ◽  
Stereotactic Biopsies

Abstract BACKGROUND Most brain biopsies are still performed with the aid of a navigation-guided mechanical arm. Due to the manual trajectory alignment without rigid skull contact, frameless aiming devices are prone to considerably lower accuracy. OBJECTIVE To compare a novel minimally invasive robot-guided biopsy technique with rigid skull fixation to a standard frameless manual arm biopsy procedure. METHODS Accuracy, procedural duration, diagnostic yield, complication rate, and cosmetic result were retrospectively assessed in 40 consecutive cases of frameless stereotactic biopsies and compared between a minimally invasive robotic technique using the iSYS1 guidance device (iSYS Medizintechnik GmbH) (robot-guided group [ROB], n = 20) and a manual arm-based technique (group MAN, n = 20). RESULTS Application of the robotic technique resulted in significantly higher accuracy at entry point (group ROB median 1.5 mm [0.4-3.2 mm] vs manual arm-based group (MAN) 2.2 mm [0.2-5.2 mm], P = .019) and at target point (group ROB 1.5 mm [0.4-2.8 mm] vs group MAN 2.8 mm [1.4-4.9 mm], P = .001), without increasing incision to suture time (group ROB 30.0 min [20-45 min vs group MAN 32.5 min [range 20-60 min], P = .09) and significantly shorter skin incision length (group ROB 16.3 mm [12.7-23.4 mm] vs group MAN 24.2 mm [18.0-37.0 mm], P = .008). CONCLUSION According to our data, the proposed technique of minimally invasive robot-guided brain biopsies can improve accuracy without increasing operating time while being equally safe and effective compared to a standard frameless arm-based manual biopsy technique.

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