Clinical application of robotic telemanipulation system in neurosurgery

2003 ◽  
Vol 99 (6) ◽  
pp. 1082-1084 ◽  
Author(s):  
Tetsuya Goto ◽  
Kazuhiro Hongo ◽  
Yukinari Kakizawa ◽  
Hisashi Muraoka ◽  
Yosuke Miyairi ◽  
...  
Keyword(s):  
Case Report ◽  
Clinical Application ◽  
Microscopic Observation ◽  
Direct Contact ◽  
Three Dimensional ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
Postoperative Course ◽  
First Case ◽  
Fine Print

✓ The NeuRobot is a telecontrolled microscopic micromanipulator system designed for neurosurgical procedures. The unit houses a three-dimensional endoscope and three robot arms that the surgeon operates without direct contact with the patient. The authors have successfully performed robotics-assisted neurosurgical procedures by using the NeuRobot in a 54-year-old man who had a recurrent atypical meningioma. Following the usual preparation of craniotomy and opening of the dura mater, a portion of the tumor was removed using the NeuRobot with the aid of microscopic observation. No complication related to the use of the NeuRobot was encountered and the patient's postoperative course was uneventful. Although various kinds of robots have been developed for use in neurosurgery in recent years, a robotic telemanipulation system capable of performing several surgical tasks has not previously been introduced to clinical neurosurgery. This is the first case report in which neurosurgical manipulation by a robotics system is described.

Intracerebral hemorrhage complicating cervical “hourglass” schwannoma removal

2001 ◽  
Vol 94 (1) ◽  
pp. 150-153 ◽  
Author(s):  
Xavier Morandi ◽  
Laurent Riffaud ◽  
Beatrice Carsin-Nicol ◽  
Yvon Guegan
Keyword(s):  
Intracerebral Hemorrhage ◽  
Surgical Procedure ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Neurosurgical Procedure ◽  
Content Type ◽  
Postoperative Course ◽  
First Case ◽  
Fine Print

✓ The authors report a case of infra- and supratentorial intracerebral hemorrhage complicating the postoperative course of a patient who had undergone surgical removal of a cervical schwannoma with an hourglass configuration. To their knowledge, this is the first case in which this neurosurgical procedure was followed by such a complication. Possible mechanisms are discussed; however, pathological events leading to this complication are unclear. The development of new neurological deficits not attributable to the surgical procedure should suggest this possibility.

High-resolution three-dimensional T2-weighted sequence for neuronavigation: a new setup and clinical trial

2005 ◽  
Vol 102 (4) ◽  
pp. 658-663 ◽  
Author(s):  
Jan Gralla ◽  
Raphael Guzman ◽  
Caspar Brekenfeld ◽  
Luca Remonda ◽  
Claus Kiefer
Keyword(s):  
Clinical Trial ◽  
High Resolution ◽  
Clinical Application ◽  
Three Dimensional ◽  
Whole Body ◽  
Low Grade ◽  
Data Set ◽  
Content Type ◽  
Image Guided ◽  
Fine Print

Object. Conventional imaging for neuronavigation is performed using high-resolution computerized tomography (CT) scanning or a T1-weighted isovoxel magnetic resonance (MR) sequence. The extension of some lesions, however, is depicted much better on T2-weighted MR images. A possible fusion process used to match low-resolution T2-weighted MR image set with a referenced CT or T1-weighted data set leads to poor resolution in the three-dimensional (3D) reconstruction and decreases accuracy, which is unacceptable for neuronavigation. The object of this work was to develop a 3D T2-weighted isovoxel sequence (3D turbo—spin echo [TSE]) for image-guided neuronavigation of the whole brain and to evaluate its clinical application. Methods. The authors performed a phantom study and a clinical trial on a newly developed T2-weighted isovoxel sequence, 3D TSE, for image-guided neuronavigation using a common 1.5-tesla MR imager (Siemens Sonata whole-body imager). The accuracy study and intraoperative image guidance were performed with the aid of the pointer-based Medtronic Stealth Station Treon. The 3D TSE data set was easily applied to the navigational setup and demonstrated a high registration accuracy during the experimental trial and during an initial prospective clinical trial in 25 patients. The sequence displayed common disposable skin fiducial markers and provided convincing delineation of lesions that appear hyperintense on T2-weighted images such as low-grade gliomas and cavernomas in its clinical application. Conclusions. Three-dimensional TSE imaging broadens the spectrum of navigational and intraoperative data sets, especially for lesions that appear hyperintense on T2-weighted images. The accuracy of its registration is very reliable and it enables high-resolution reconstruction in any orientation, maintaining the advantages of image-guided surgery.

Quantification of increased exposure resulting from orbital rim and orbitozygomatic osteotomy via the frontotemporal transsylvian approach

1999 ◽  
Vol 91 (6) ◽  
pp. 1020-1026 ◽  
Author(s):  
Marc S. Schwartz ◽  
Gregory J. Anderson ◽  
Michael A. Horgan ◽  
Jordi X. Kellogg ◽  
Sean O. McMenomey ◽  
...  
Keyword(s):  
Dimensional Space ◽  
Three Dimensional ◽  
Zygomatic Arch ◽  
Neurosurgical Procedures ◽  
Content Type ◽  
Transsylvian Approach ◽  
Surgical Access ◽  
Stereotactic Device ◽  
Orbital Rim ◽  
Fine Print

Object. Use of orbital rim and orbitozygomatic osteotomy has been extensively reported to increase exposure in neurosurgical procedures. However, there have been few attempts to quantify the extent of additional exposure gained by these maneuvers. Using a novel laboratory technique, the authors have attempted to measure the increase in the “area of exposure” that is gained by removal of the orbital rim and zygomatic arch via the frontotemporal transsylvian approach.Methods. The authors dissected five cadavers bilaterally. The area of exposure provided by the frontotemporal transsylvian approach was determined by using a frameless stereotactic device. With the tip of a microdissector placed on targets deep within the exposure, the position of the end of the microdissector handle was measured in three-dimensional space as the microdissector was rotated around the periphery of the operative field. This maneuver was performed via the frontotemporal approach alone as well as with orbital rim and orbitozygomatic osteotomy approaches. After data manipulation, the areas of exposure corresponding to the polygons used to define these handle positions were calculated and directly compared. On average, the area of exposure provided by the frontotemporal transsylvian approach was increased 26 to 39% (p < 0.05) by adding orbital rim osteotomy and an additional 13 to 22% (not significant) with removal of the zygomatic arch.Conclusions. Significant and consistent increases in surgical exposure were obtained by using orbital osteotomy, whereas zygomatic arch removal produced less consistent gains. Both maneuvers may be expected to improve surgical access. However, because larger and more consistent gains were afforded by orbital rim removal, the threshold for removal of this portion of the orbitozygomatic complex should be lower.

Recurrent chemical meningitis due to an intraspinal cystic teratoma

1980 ◽  
Vol 52 (5) ◽  
pp. 715-717 ◽  
Author(s):  
Albert Larbrisseau ◽  
Francois Renevey ◽  
Pierre Brochu ◽  
Michel Décarie ◽  
Jean-Pierre Mathieu
Keyword(s):  
Case Report ◽  
Cystic Teratoma ◽  
Content Type ◽  
First Case ◽  
Chemical Meningitis ◽  
Space Occupying Lesion ◽  
Fine Print

✓ This is the first case report of an intraspinal cystic teratoma that manifested itself in recurrent episodes of chemical meningitis, with no sign of a space-occupying lesion.

Intraosseous glomus tumor of the spine

1996 ◽  
Vol 85 (2) ◽  
pp. 344-347 ◽  
Author(s):  
James C. Robinson ◽  
Scott E. Kilpatrick ◽  
David L. Kelly
Keyword(s):  
Back Pain ◽  
Case Report ◽  
Lumbar Spine ◽  
Glomus Tumor ◽  
Radiographic Findings ◽  
Content Type ◽  
Glomus Tumors ◽  
First Case ◽  
Fine Print

✓ The authors report a case of glomus tumor originating within the lumbar spine. Glomus tumors of intraosseous origin are rare, with the only case reported in the spine arising in the sacrum. The patient presented with the solitary complaint of radiating back pain that resolved postoperatively. The histopathological and radiographic findings are reviewed. To the authors' knowledge, this represents the first case report of a glomus tumor of the spine originating above the sacrum.

Intraoperative stereoscopic QuickTime Virtual Reality

2004 ◽  
Vol 100 (4) ◽  
pp. 591-596 ◽  
Author(s):  
Attila Balogh ◽  
Mark C. Preul ◽  
Mark Schornak ◽  
Michael Hickman ◽  
Robert F. Spetzler
Keyword(s):  
Virtual Reality ◽  
Image Acquisition ◽  
Three Dimensional ◽  
Neurosurgical Procedures ◽  
Digital Cameras ◽  
Content Type ◽  
Left And Right ◽  
Software And Hardware ◽  
Image Pairs ◽  
Fine Print

Object. The aim of this study was to acquire intraoperative images during neurosurgical procedures for later reconstruction into a stereoscopic image system (QuickTime Virtual Reality [QTVR]) that would improve visualization of complex neurosurgical procedures. Methods. A robotic microscope and digital cameras were used to acquire left and right image pairs during cranial surgery; a grid system facilitated image acquisition with the microscope. The surgeon determined a field of interest and a target or pivot point for image acquisition. Images were processed with commercially available software and hardware. Two-dimensional (2D) or interlaced left and right 2D images were reconstructed into a standard or stereoscopic QTVR format. Standard QTVR images were produced if stereoscopy was not needed. Intraoperative image sequences of regions of interest were captured in six patients. Relatively wide and deep dissections afford an opportunity for excellent QTVR production. Narrow or restricted surgical corridors can be reconstructed into the stereoscopic QTVR mode by using a keyhole mode of image acquisition. The stereoscopic effect is unimpressive with shallow or cortical surface dissections, which can be reconstructed into standard QTVR images. Conclusions. The QTVR system depicts multiple views of the same anatomy from different angles. By tilting, panning, or rotating the reconstructed images, the user can view a virtual three-dimensional tour of a neurosurgical dissection, with images acquired intraoperatively. The stereoscopic QTVR format provides depth to the montage. The system recreates the dissection environment almost completely and provides a superior anatomical frame of reference compared with the images captured by still or video photography in the operating room.

Stereotactic radiosurgery versus stereotactic radiotherapy for patients with vestibular schwannoma: a Leksell Gamma Knife Society 2000 debate

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 90-92 ◽  
Author(s):  
Mark E. Linskey
Keyword(s):  
Gamma Knife ◽  
Stereotactic Radiotherapy ◽  
Three Dimensional ◽  
Late Recurrence ◽  
Vestibular Schwannomas ◽  
Tumor Control ◽  
Complication Rates ◽  
Content Type ◽  
Single Fraction ◽  
Fine Print

✓ By definition, the term “radiosurgery” refers to the delivery of a therapeutic radiation dose in a single fraction, not simply the use of stereotaxy. Multiple-fraction delivery is better termed “stereotactic radiotherapy.” There are compelling radiobiological principles supporting the biological superiority of single-fraction radiation for achieving an optimal therapeutic response for the slowly proliferating, late-responding, tissue of a schwannoma. It is axiomatic that complication avoidance requires precise three-dimensional conformality between treatment and tumor volumes. This degree of conformality can only be achieved through complex multiisocenter planning. Alternative radiosurgery devices are generally limited to delivering one to four isocenters in a single treatment session. Although they can reproduce dose plans similar in conformality to early gamma knife dose plans by using a similar number of isocenters, they cannot reproduce the conformality of modern gamma knife plans based on magnetic resonance image—targeted localization and five to 30 isocenters. A disturbing trend is developing in which institutions without nongamma knife radiosurgery (GKS) centers are championing and/or shifting to hypofractionated stereotactic radiotherapy for vestibular schwannomas. This trend appears to be driven by a desire to reduce complication rates to compete with modern GKS results by using complex multiisocenter planning. Aggressive advertising and marketing from some of these centers even paradoxically suggests biological superiority of hypofractionation approaches over single-dose radiosurgery for vestibular schwannomas. At the same time these centers continue to use the term radiosurgery to describe their hypofractionated radiotherapy approach in an apparent effort to benefit from a GKS “halo effect.” It must be reemphasized that as neurosurgeons our primary duty is to achieve permanent tumor control for our patients and not to eliminate complications at the expense of potential late recurrence. The answer to minimizing complications while maintaining maximum tumor control is improved conformality of radiosurgery dose planning and not resorting to homeopathic radiosurgery doses or hypofractionation radiotherapy schemes.

The use of intraarterial papaverine in the management of vasospasm complicating arteriovenous malformation resection

1995 ◽  
Vol 82 (2) ◽  
pp. 296-299 ◽  
Author(s):  
Michael K. Morgan ◽  
Maurice J. Day ◽  
Nicholas Little ◽  
Verity Grinnell ◽  
William Sorby
Keyword(s):  
Arteriovenous Malformation ◽  
Perfusion Pressure ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Venous Occlusion ◽  
Neurological Deterioration ◽  
Unusual Complication ◽  
Content Type ◽  
First Case ◽  
Normal Perfusion Pressure Breakthrough ◽  
Fine Print

✓ The authors report two cases of treatment by intraarterial papaverine of cerebral vasospasm complicating the resection of an arteriovenous malformation (AVM). Both cases had successful reversal of vasospasm documented on angiography. In the first case sustained neurological improvement occurred, resulting in a normal outcome by the time of discharge. In the second case, neurological deterioration occurred with the development of cerebral edema. This complication was thought to be due to normal perfusion pressure breakthrough, on the basis of angiographic arterial vasodilation and increased cerebral blood flow. These two cases illustrate an unusual complication of surgery for AVMs and demonstrate that vasospasm (along with intracranial hemorrhage, venous occlusion, and normal perfusion pressure breakthrough) should be considered in the differential diagnosis of delayed neurological deterioration following resection of these lesions. Although intraarterial papaverine may be successful in dilating spastic arteries, it may also result in pathologically high flows following AVM resection. However, this complication has not been seen in our experience of treating aneurysmal subarachnoid hemorrhage by this technique.

Biomechanical characteristics of C1–2 cable fixations

1996 ◽  
Vol 85 (2) ◽  
pp. 316-322 ◽  
Author(s):  
Curtis A. Dickman ◽  
Neil R. Crawford ◽  
Christopher G. Paramore
Keyword(s):  
Cyclic Loading ◽  
Translational Motion ◽  
Biomechanical Testing ◽  
Three Dimensional ◽  
Constrained Motion ◽  
Content Type ◽  
Physiological Range ◽  
Fixation Techniques ◽  
Cable Fixation ◽  
Fine Print

✓ The biomechanical characteristics of four different methods of C1–2 cable fixation were studied to assess the effectiveness of each technique in restoring atlantoaxial stability. Biomechanical testing was performed on the upper cervical spines of four human cadaveric specimens. Physiological range loading was applied to the atlantoaxial specimens and three-dimensional motion was analyzed with stereophotogrammetry. The load–deformation relationships and kinematics were measured, including the stiffness, the angular ranges of motion, the linear ranges of motion, and the axes of rotation. Specimens were nondestructively tested in the intact state, after surgical destabilization, and after each of four different methods of cable fixation. Cable fixation techniques included the interspinous technique, the Brooks technique, and two variants of the Gallie technique. All specimens were tested immediately after fixation and again after the specimen was fatigued with 6000 cycles of physiological range torsional loading. All four cable fixation methods were moderately flexible immediately; the different cable fixations allowed between 5° and 40° of rotational motion and between 0.6 and 7 mm of translational motion to occur at C1–2. The Brooks and interspinous methods controlled C1–2 motion significantly better than both of the Gallie techniques. The motion allowed by one of the Gallie techniques did not differ significantly from the motion of the unfixed destabilized specimens. All cable fixation techniques loosened after cyclic loading and demonstrated significant increases in C1–2 rotational and translational motions. The bone grafts shifted during cyclic loading, which reduced the effectiveness of the fixation. The locations of the axes of rotation, which were unconstrained and mobile in the destabilized specimens, became altered with cable fixation. The C1–2 cables constrained motion by shifting the axes of rotation so that C-1 rotated around the fixed cable and graft site. After the specimen was fatigued, the axes of rotation became more widely dispersed but were usually still localized near the cable and graft site. Adequate healing requires satisfactory control of C1–2 motion. Therefore, some adjunctive fixation is advocated to supplement the control of motion after C1–2 cable fixation (that is, a cervical collar, a halo brace, or rigid internal fixation with transarticular screws).

Cerebral hemorrhage and edema following brain biopsy in rats: significance of mean arterial blood pressure

2000 ◽  
Vol 92 (1) ◽  
pp. 100-107 ◽  
Author(s):  
Helene Benveniste ◽  
Katie R. Kim ◽  
Laurence W. Hedlund ◽  
John W. Kim ◽  
Allan H. Friedman
Keyword(s):  
Blood Pressure ◽  
Arterial Blood Pressure ◽  
Mean Arterial Blood Pressure ◽  
Neurosurgical Procedures ◽  
Shr Rats ◽  
Mr Microscopy ◽  
Content Type ◽  
Wky Rats ◽  
Arterial Blood ◽  
Fine Print

Object. It is taken for granted that patients with hypertension are at greater risk for intracerebral hemorrhage during neurosurgical procedures than patients with normal blood pressure. The anesthesiologist, therefore, maintains mean arterial blood pressure (MABP) near the lower end of the autoregulation curve, which in patients with preexisting hypertension can be as high as 110 to 130 mm Hg. Whether patients with long-standing hypertension experience more hemorrhage than normotensive patients after brain surgery if their blood pressure is maintained at the presurgical hypertensive level is currently unknown. The authors tested this hypothesis experimentally in a rodent model.Methods. Hemorrhage and edema in the brain after needle biopsy was measured in vivo by using three-dimensional magnetic resonance (MR) microscopy in the following groups: WKY rats, acutely hypertensive WKY rats, spontaneously hypertensive rats (SHR strain), and SHR rats treated with either sodium nitroprusside or nicardipine. Group differences were compared using Tukey's studentized range test followed by individual pairwise comparisons of groups and adjusted for multiple comparisons.There were no differences in PaCO2, pH, and body temperature among the groups. The findings in this study indicated that only acutely hypertensive WKY rats had larger volumes of hemorrhage. Chronically hypertensive SHR rats with MABPs of 130 mm Hg did not have larger hemorrhages than normotensive rats. There were no differences in edema volumes among groups.Conclusions. The brains of SHR rats with elevated systemic MABPs are probably protected against excessive hemorrhage during surgery because of greater resistance in the larger cerebral arteries and, thus, reduced cerebral intravascular pressures.

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