Robotically Steered Needles: A Survey of Neurosurgical Applications and Technical Innovations

This paper surveys both the clinical applications and main technical innovations related to steered needles, with an emphasis on neurosurgery. Technical innovations generally center on curvilinear robots that can adopt a complex path that circumvents critical structures and eloquent brain tissue. These advances include several needle-steering approaches, which consist of tip-based, lengthwise, base motion-driven, and tissue-centered steering strategies. This paper also describes foundational mathematical models for steering, where potential fields, nonholonomic bicycle-like models, spring models, and stochastic approaches are cited. In addition, practical path planning systems are also addressed, where we cite uncertainty modeling in path planning, intraoperative soft tissue shift estimation through imaging scans acquired during the procedure, and simulation-based prediction. Neurosurgical scenarios tend to emphasize straight needles so far, and span deep-brain stimulation (DBS), stereoelectroencephalography (SEEG), intracerebral drug delivery (IDD), stereotactic brain biopsy (SBB), stereotactic needle aspiration for hematoma, cysts and abscesses, and brachytherapy as well as thermal ablation of brain tumors and seizure-generating regions. We emphasize therapeutic considerations and complications that have been documented in conjunction with these applications

Mixed Reality in Modern Surgical and Interventional Practice: Narrative Review of the Literature

BACKGROUND Mixed reality (MR) and its potential applications have gained increasing interest within the medical community over the recent years. The ability to integrate virtual objects into a real-world environment within a single video-see-through display is a topic that sparks imagination. Given these characteristics, MR could facilitate preoperative and preinterventional planning, provide intraoperative and intrainterventional guidance, and aid in education and training, thereby improving the skills and merits of surgeons and residents alike. OBJECTIVE In this narrative review, we provide a broad overview of the different applications of MR within the entire spectrum of surgical and interventional practice and elucidate on potential future directions. METHODS A targeted literature search within the PubMed, Embase, and Cochrane databases was performed regarding the application of MR within surgical and interventional practice. Studies were included if they met the criteria for technological readiness level 5, and as such, had to be validated in a relevant environment. RESULTS A total of 57 studies were included and divided into studies regarding preoperative and interventional planning, intraoperative and interventional guidance, as well as training and education. CONCLUSIONS The overall experience with MR is positive. The main benefits of MR seem to be related to improved efficiency. Limitations primarily seem to be related to constraints associated with head-mounted display. Future directions should be aimed at improving head-mounted display technology as well as incorporation of MR within surgical microscopes, robots, and design of trials to prove superiority

Development status and application of neuronavigation system

The neuronavigation system is a combination of navigation technology and neurosurgery. It can be used to assist in neurosurgery through three-dimensional reconstruction of medical image data, extraction of lesions, optimal surgical path planning, tracking and positioning of surgical instruments, and real-time intraoperative display. Accurate and maximal treatment of lesions, while effectively avoiding secondary injuries to patients during surgery. Therefore, the development and application of neuronavigation systems are reviewed

Image guidance in neurosurgical procedures, the "Visages" point of view.

This paper gives an overview of the evolution of clinical neuroinformatics in the domain of neurosurgery. It shows how image guided neurosurgery (IGNS) is evolving according to the integration of new imaging modalities before, during and after the surgical procedure and how this acts as the premise of the Operative Room of the future. These different issues, as addressed by the VisAGeS INRIA/INSERM U746 research team (http://www.irisa.fr/visages), are presented and discussed in order to exhibit the benefits of an integrated work between physicians (radiologists, neurologists and neurosurgeons) and computer scientists to give adequate answers toward a more effective use of images in IGNS

A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future

none4openZaffino, Paolo; Moccia, Sara; De Momi, Elena; Spadea, Maria FrancescaZaffino, Paolo; Moccia, Sara; De Momi, Elena; Spadea, Maria Francesc

New surgical methods and complications of scoliosis surgery in paediatric patients

Scoliosis surgery may be associated with major blood loss and postoperative voiding difficulties. The magnetically controlled growing rod (MCGR) is the latest innovation developed for early onset scoliosis treatment. Patients with neuromuscular disorders often have an increased risk of pneumonia and decreased lung function, which may further be compromised by scoliosis. Thisthesis examines new surgical methods for scoliosis in paediatric patients, specifically, the effect of adding gelatine matrix with human thrombin to the standard surgical methods of controlling blood loss, and the effectiveness of the MCGR technique in previously operated children. This study also evaluates the effect of scoliosis surgery on the risk of pneumonia in patients with neuromuscular scoliosis (NMS) and on the risk of postoperative voiding difficulties in young patients undergoing posterior spinal fusion (PSF) for idiopathic scoliosis. The study consists of four separate parts with different study populations in each part (in total, 263 patients). One study is a randomised clinical trial, one is a prospective cohort study and the other two are retrospective studies. All the patients of the study were children or young adults under the age of 21. Data for one part of the study was collected from various countries; the three other parts used data solely from the Finnish population. The addition of gelatine matrix with human thrombin to conventional methods of achieving haemostasis reduces both intraoperative blood loss and the decrease in haemoglobin concentration postoperatively in adolescents undergoing posterior spinal fusion for idiopathic scoliosis. Scoliosis can be equally controlled after conversion from traditional growing rods to MCGRs, but spinal growth from baseline is less in conversion patients, compared to that of the primary group. Scoliosis surgery does not decrease the incidence of pneumonia in patients with severe NMS. Postoperative voiding difficulties affect almost half of the patients under 21 years of age undergoing PSF for idiopathic scoliosis. The main risk factors were found to be increased intraoperative blood loss, longer length of surgery and male gender.Skolioosikirurgian uudet leikkausmenetelmät ja komplikaatiot lapsipotilailla, Skolioosikirurgiaan voi liittyä sekä merkittävä verenvuoto että leikkauksen jälkeinen virtsaamisvaikeus. Magneettipidennettävä tanko on uusin instrumentaatio, joka on kehitetty varhain alkavan skolioosin hoitoon. Neuromuskulaarista tautia sairastavilla on kohonnut keuhkokuumeen riski sekä alentunut keuhkojen toiminta, jota skolioosi voi edelleen heikentää. Tässä väitöskirjassa tutkitaan uusia leikkausmenetelmiä skolioosikirurgiassa; gelatiini matrixin vaikutusta leikkausverenvuotoon ja magneettipidennettävän tangon toimivuutta aiemmin leikatuilla potilailla. Lisäksi tavoitteena oli selvittää skolioosikirurgian vaikutus keuhkokuumeen riskiin neuromuskulaarista skolioosia sairastavilla potilailla sekä skolioosikirurgian vaikutus leikkauksen jälkeiseen virtsaamisongelmaan. Väitöskirja koostuu neljästä erillisestä osatyöstä, joissa kaikissa on eri tutkimuspopulaatio (yhteensä 263 potilasta). Yksi osatyö on satunnaistettu etenevä tutkimus, yksi on etenevä kohorttitutkimus ja loput kaksi ovat tehty takautuvasti. Kaikki tutkimuksiin osallistuvat olivat lapsia tai nuoria aikuisia, iältään alle 21-vuotta. Yhden osatyön potilasaineisto on koottu useasta maasta, muut olivat suomalaisesta väestöstä. Gelatiini matrixi muiden verenvuodon kontrollointimenetelmien ohessa käytettynä vähentää leikkauksen aikaista verenvuotoa ja leikkauksen jälkeistä hemoglobiinin laskua idiopaattisen skolioosin vuoksi posteriorisesti leikatuilla nuorilla. Skolioosikäyryys on hallittavissa kun vaihdetaan perinteiset pidennettävät tangot magneettipidennettäviin tankoihin, mutta selkärangan kasvu lähtötasosta on vähäisempää konversioleikatuilla kuin primaaristi magneettipidennettävillä tangoilla leikatuilla. Skolioosikirurgia ei vähennä keuhkokuumeen ilmaantuvuutta neuromuskulaarista skolioosia sairastavilla potilailla. Noin puolella idiopaattisen skolioosin vuoksi posteriorisesti leikatuilla alle 21-vuotiailla nuorilla on leikkauksen jälkeisiä virtsaamisvaikeuksia. Riskitekijät virtsaamisvaikeuksille ovat lisääntynyt leikkauksen aikainen verenvuoto, pitkä leikkauksen kesto sekä mies sukupuoli

Point-of-care manufacturing: a single university hospital's initial experience

The integration of 3D printing technology in hospitals is evolving toward production models such as point-of-care manufacturing. This study aims to present the results of the integration of 3D printing technology in a manufacturing university hospital.Analysis and interpretation of the data supported by Project PI18/01625 (Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III) and European Regional Development Fund (“Una manera de hacer Europa”)

Sensorimotor Mapping With MEG: An Update on the Current State of Clinical Research and Practice With Considerations for Clinical Practice Guidelines

Published: November 2020In this article, we present the clinical indications and advances in the use of magnetoencephalography to map the primary sensorimotor (SM1) cortex in neurosurgical patients noninvasively. We emphasize the advantages of magnetoencephalography over sensorimotor mapping using functional magnetic resonance imaging. Recommendations to the referring physicians and the clinical magnetoencephalographers to achieve appropriate sensorimotor cortex mapping using magnetoencephalography are proposed. We finally provide some practical advice for the use of corticomuscular coherence, corticokinematic coherence, and mu rhythm suppression in this indication. Magnetoencephalography should now be considered as a method of reference for presurgical functional mapping of the sensorimotor cortex.X. De Ti ege is Post-doctorate Clinical Master Specialist at the Fonds de la Recherche Scientifique (FRS-FNRS, Brussels, Belgium). M. Bourguignon has been supported by the program Attract of Innoviris (Grant 2015-BB2B-10), by the Spanish Ministry of Economy and Competitiveness (Grant PSI2016- 77175-P), and by the Marie Sk1odowska-Curie Action of the European Commission (Grant 743562). H. Piitulainen has been supported by the Academy of Finland (Grants #266133 and #296240), the Jane and Aatos Erkko Foundation, and the Emil Aaltonen Foundation. The authors thank Professor Riitta Hari for her support in most of the research works published by the authors and presented in this article. The MEG project at the CUB H^opital Erasme is financially supported by the Fonds Erasme (Research convention “Les Voies du Savoir,” Fonds Erasme, Brussels, Belgium)

Multiple classifier fusion and optimization for automatic focal cortical dysplasia detection on magnetic resonance images

In magnetic resonance (MR) images, detection of focal cortical dysplasia (FCD) lesion as a main pathological cue of epilepsy is challenging because of the variability in the presentation of FCD lesions. Existing algorithms appear to have sufficient sensitivity in detecting lesions but also generate large numbers of false-positive (FP) results. In this paper, we propose a multiple classifier fusion and optimization schemes to automatically detect FCD lesions in MR images with reduced FPs through constructing an objective function based on the F-score. Thus, the proposed scheme obtains an improved tradeoff between minimizing FPs and maximizing true positives. The optimization is achieved by incorporating the genetic algorithm into the work scheme. Hence, the contribution of weighting coefficients to different classifications can be effectively determined. The resultant optimized weightings are applied to fuse the classification results. A set of six typical FCD features and six corresponding Z-score maps are evaluated through the mean F-score from multiple classifiers for each feature. From the experimental results, the proposed scheme can automatically detect FCD lesions in 9 out of 10 patients while correctly classifying 31 healthy controls. The proposed scheme acquires a lower FP rate and a higher F-score in comparison with two state-of-the-art methods