NAVIGATION GUIDED NEUROSURGERY – A NEW FRONTIER & A PRACTICE OF SAFE & PREDICTABLE NEUROSURGERY
Salem, June 20, 2016: Today, doctors are using computerized technologies that are familiar to people in the consumer world to help find the target lesion like tumor and the target location in the operating room. An important example of that application is image guided surgery (IGS) and it helps surgeons perform safer and less invasive procedures and remove brain tumors that were once considered inoperable due to their size and/or location it also helps reaching a desired target precisely without causing undue damage to surrounding tissue
Image-guided surgeryis the general term used for any surgical procedure where the surgeon employs tracked surgical instruments in conjunction with preoperative or intra operative images in order to indirectly guide the procedure. Similar to a car or mobile Global Positioning System (GPS), image guided surgery systems use cameras or electromagnetic fields to capture and relay the patient’s anatomy and the surgeon’s precise movements in relation to the patient, to computer monitors in the operating room. These sophisticated computerized systems, like Curve Image Guided Surgery, Kick Navigation and Stealth Station are used before and during surgery to help orient the surgeon with three-dimensional images of the patient’s anatomy including the tumor.
The various applications of navigation for neurosurgery have been widely used and reported for almost two decades]According to a study in 2000, researchers were already anticipating that a significant portion of neurosurgery would be performed using computer-based interventions.
Part of the wider field of computer-assisted surgery, image-guided surgery can take place in hybrid operating rooms using intra operative imaging. A hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, CT scanners or MRI scanners. Most image-guided surgical procedures are minimally invasive. A field of medicine that pioneered and specializes in minimally invasive image-guided surgery is navigation guided or assisted neurosurgery
Image-guided surgery was originally developed for treatment of brain tumors using stereotactic surgery and radiosurgery that are guided by computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) using a technology known as the frameless stereotaxy. Image-guided surgery has found wide application in surgery of the deep seated lesion in the critical brain structure where it helps to avoid damage to brain and important neurovascular structure.
A hand-held surgical probe is an essential component of any image-guided surgery system. orthogonal image slices on a workstation-based 3D imaging system is required to be obtained preoperatively and should be uploaded to the image guidance system memory. Existing IGS systems use different tracking techniques including mechanical, optical, ultrasonic, and electromagnetic.
The image guided system can be used in the following neurosurgical operation and also provides intra operatively real time accurate information in relation to the particular location of the target lesion and the surrounding brain structure.
In this particular case we have used neuro navigation for the first time in this region at Salem Manipal hospital .we have used an indigenously built navigation system built in India, which reduces the cost significantly as well benefit the patients from high end specific safe neurosurgery
We have a 4y old child with hydrocephalus for ventriculoperitoneal shunt. We decided to approach the case through the right occipital horn .ventricular entry required a specific target avoiding critical structure like posterior limb of internal capsule as well as visual cortex.As this procedure is a blind, sometimes multiple attempts to puncture the ventricle is a necessicity as well as occasionally leads to faulty placement in the parenchyma as well as malposition of the shunt leading to multiple operation as well as complication.
Procedure for the image guided surgery.
Patient should be required to undergo navigation protocol CT scan of the brain and which required to be loaded in the system. Patient required to be in the operative couch with facing the infrared camera in standstill. No movement of the patient as well as the interference between the camera and the patient is allowed.
The image guided wand locates and interact with the camera and gives a real time anatomical information as per the image and real time feed back to the surgeon and achieves precision.
We managed to cannulate the ventricle precisely and also accurate placement inside the frontal horn. Patient improved and ventricle decompressed.
Other application of the image guided system in neurosurgery
our second case a Pitutary adenoma located critically between the optic nerve , internal carotid artery and at the base of the skull between the junction of the brain and nose been approached thorugh the nose without opening the skull.
And the tumor is successfully removed. Navigation helped us in deciding the safe trajectory to the tumor as well as guided us during the excision as we approached the brain through the nose
- Deep located lesion of the brain
- functional neurosurgery while placement of deep electrodes
- loquent cortex surface lesion.
- ventriculo peritoneal shunt
- Skull base lesion.
ConclusionNavigation guided neurosurgery is the currently the must have in providing high end neurosurgery solution in critical location as well as achieving successful outcome. Availability of indigenously built navigation system , cuts down the cost of treatment significantly as well as pass the benefits to the unaffordable patients the best of both as high precision neurosurgery as well as best outcome in low cost setting