Journal articles: 'Neurosurgical device'

1

Seidelman, Jessica, and Sarah S. Lewis. "Neurosurgical Device-Related Infections." Infectious Disease Clinics of North America 32, no. 4 (December 2018): 861–76. http://dx.doi.org/10.1016/j.idc.2018.06.006.

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Li, Khan W., Clarke Nelson, Ian Suk, and George I. Jallo. "Neuroendoscopy: past, present, and future." Neurosurgical Focus 19, no. 6 (December 2005): 1–5. http://dx.doi.org/10.3171/foc.2005.19.6.2.

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Neuroendoscopy began with a desire to visualize the ventricles and deeper structures of the brain. Unfortunately, the technology available to early neuroendoscopists was not sufficient in most cases for these purposes. The unique perspective that neuroendoscopy offered was not fully realized until key technological advances made reliable and accurate visualization of the brain and ventricles possible. After this technology was incorporated into the device, neuro-endoscopic procedures were rediscovered by neurosurgeons. Endoscopic third ventriculostomy and other related procedures are now commonly used to treat a wide array of neurosurgically managed conditions. A seemingly limitless number of neurosurgical applications await the endoscope. In the future, endoscopy is expected to become routine in modern neurosurgical practice and training.

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Adams, L. P., B. A. Van Geems, G. G. Jaros, J. Peters, and S. Wynchank. "Stereophotogrammetric-controlled pointing device for neurosurgical use." Medical and Biological Engineering and Computing 33, no. 2 (March 1995): 212–17. http://dx.doi.org/10.1007/bf02523044.

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Dlouhy, Brian J., Nader S. Dahdaleh, and Jeremy D. W. Greenlee. "Emerging technology in intracranial neuroendoscopy: application of the NICO Myriad." Neurosurgical Focus 30, no. 4 (April 2011): E6. http://dx.doi.org/10.3171/2011.2.focus10312.

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Improvement in fiber optics and imaging paved the way for tremendous advancements in neuroendoscopy. These advancements have led to increasingly widespread use of the endoscope in neurosurgical procedures, which in turn incited a technological revolution leading to new approaches, instruments, techniques, and a diverse armamentarium for the treatment of a variety of neurosurgical disorders. Soft-tissue removal is often a rate-limiting aspect to endoscopic procedures, especially when the soft tissue is dense or fibrous. The authors review a series of cases involving patients treated between August 2009 and October 2010 with a new device (the NICO Myriad), a non–heat-generating, oscillating, cutting, and tissue removal instrument that can be used through the working channel of the endoscope as well as in open neurosurgical procedures. They used this device in 14 purely endoscopic intracranial procedures and 1 endoscope-assisted keyhole craniotomy. They report that the device was easy to use and found that tissue resection was more efficient than with other available endoscopic instruments, especially in the resection of fibrotic tissue. There were no observed device-related complications. The authors discuss the technical aspects of using this device in endoscopic resection of pituitary tumors, craniopharyngiomas, and colloid cysts. They also demonstrate its use in hydrocephalus and intraventricular clot removal and discuss its potential use in other neurosurgical disorders.

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Eftekhar, Behzad. "App-assisted external ventricular drain insertion." Journal of Neurosurgery 125, no. 3 (September 2016): 754–58. http://dx.doi.org/10.3171/2015.6.jns1588.

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The freehand technique for insertion of an external ventricular drain (EVD) is based on fixed anatomical landmarks and does not take individual variations into consideration. A patient-tailored approach based on augmented-reality techniques using devices such as smartphones can address this shortcoming. The Sina neurosurgical assist (Sina) is an Android mobile device application (app) that was designed and developed to be used as a simple intraoperative neurosurgical planning aid. It overlaps the patient's images from previously performed CT or MRI studies on the image seen through the device camera. The device is held by an assistant who aligns the images and provides information about the relative position of the target and EVD to the surgeon who is performing EVD insertion. This app can be used to provide guidance and continuous monitoring during EVD placement. The author describes the technique of Sina-assisted EVD insertion into the frontal horn of the lateral ventricle and reports on its clinical application in 5 cases as well as the results of ex vivo studies of ease of use and precision. The technique has potential for further development and use with other augmented-reality devices.

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Kashiwagi, Shiro, Tetsuo Yamashita, Yuuki Eguchi, Yujiro Shiroyama, Haruhide Ito, and Tsuyoshi Maekawa. "An Intracranial Temperature Monitoring Device for Neurosurgical Patients." Japanese Journal of Neurosurgery 1, no. 2 (1992): 167–69. http://dx.doi.org/10.7887/jcns.1.167.

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Braxton, Ernest E., Garth D. Ehrlich, Luanne Hall-Stoodley, Paul Stoodley, Rick Veeh, Christoph Fux, Fen Z. Hu, Matthew Quigley, and J. Christopher Post. "Role of biofilms in neurosurgical device-related infections." Neurosurgical Review 28, no. 4 (July 1, 2005): 249–55. http://dx.doi.org/10.1007/s10143-005-0403-8.

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Bergman, William C., Raymond A. Schulz, and Deanna S. Davis. "Factors influencing the genesis of neurosurgical technology." Neurosurgical Focus 27, no. 3 (September 2009): E3. http://dx.doi.org/10.3171/2009.6.focus09117.

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For any new technology to gain acceptance, it must not only adequately fill a true need, but must also function optimally within the confines of coexisting technology and concurrently available support systems. As an example, over the first decades of the 20th century, a number of drill designs used to perform cranial bone cuts appeared, fell out of favor, and later reappeared as certain supportive technologies emerged. Ultimately, it was the power source that caused one device to prevail. In contrast, a brilliant imaging device, designed to demonstrate an axial view of the lumbar spine, was never allowed to gain acceptance because it was immediately superseded by another device of no greater innovation, but one that performed optimally with popular support technology. The authors discuss the factors that have bearing on the evolution of neurosurgical technology.

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Maddahi, Yaser, Kourosh Zareinia, Boguslaw Tomanek, and Garnette R. Sutherland. "Challenges in developing a magnetic resonance–compatible haptic hand-controller for neurosurgical training." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 232, no. 12 (October 24, 2018): 1148–67. http://dx.doi.org/10.1177/0954411918806934.

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A haptic device is an actuated human–machine interface utilized by an operator to dynamically interact with a remote environment. This interaction could be virtual (virtual reality) or physical such as using a robotic arm. To date, different mechanisms have been considered to actuate the haptic device to reflect force feedback from the remote environment. In a low-force environment or limited working envelope, the control of some actuation mechanisms such as hydraulic and pneumatic may be problematic. In the development of a haptic device, challenges include limited space, high accuracy or resolution, limitations in kinematic and dynamic solutions, points of singularity, dexterity as well as control system development/design. Furthermore, the haptic interface designed to operate in a magnetic resonance imaging environment adds additional challenges related to electromagnetic interference, static/variable magnetic fields, and the use of magnetic resonance–compatible materials. Such a device would allow functional magnetic resonance imaging to obtain information on the subject’s brain activity while performing a task. When used for surgical trainees, functional magnetic resonance imaging could provide an assessment of surgical skills. In this application, the trainee, located supine within the magnet bore while observing the task environment on a graphical user interface, uses a low-force magnetic resonance–compatible haptic device to perform virtual surgical tasks in a limited space. In the quest to develop such a device, this review reports the multiple challenges faced and their potential solutions. The review also investigates efforts toward prototyping such devices and classifies the main components of a magnetic resonance–compatible device including actuation and sensory systems and materials used.

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Bleasel, Kevin F., and Richard B. Frost. "A new neurosurgical irrigating sucking cutter." Journal of Neurosurgery 65, no. 1 (July 1986): 120–21. http://dx.doi.org/10.3171/jns.1986.65.1.0120.

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✓ A new instrument has been developed for the removal of tumors located in areas difficult to reach. It operates by suctioning and cutting tissue, and is equipped with an irrigating sucker. This device is described and its successful use in clinical practice is summarized.

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Chaskis, Elly, Niloufar Sadeghi, Olivier De Witte, and Florence Lefranc. "Neurosurgical Device Implantation for Neurooncologic Patients: What To Avoid?" World Neurosurgery 124 (April 2019): 298–303. http://dx.doi.org/10.1016/j.wneu.2019.01.035.

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Payne, Christopher J., Hani J. Marcus, and Guang-Zhong Yang. "A Smart Haptic Hand-Held Device for Neurosurgical Microdissection." Annals of Biomedical Engineering 43, no. 9 (January 29, 2015): 2185–95. http://dx.doi.org/10.1007/s10439-015-1258-y.

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KOBAYASHI, Osuke, Kazuhiko ADACHI, Keitaro SHOJI, Atsushi FUJIITA, and Eiji KOHMURA. "403 Development of Neurosurgical Training System Using Haptic Device." Proceedings of Conference of Kansai Branch 2011.86 (2011): _4–3_. http://dx.doi.org/10.1299/jsmekansai.2011.86._4-3_.

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Konovalov, Anton, Dmitry Okishev, Oleg Shekhtman, Yuri Pilipenko, and Shalva Eliava. "Neuronavigation device for stereotaxic external ventricular drainage insertion." Surgical Neurology International 12 (June 7, 2021): 266. http://dx.doi.org/10.25259/sni_180_2021.

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Background: The insertion of an external ventricular drainage (EVD) is one of the most frequently used neurosurgical procedures. It is performed to adjust intracranial hypertension in cases of severe craniocerebral injury, acute posthemorrhagic hydrocephalus, meningitis, and oncological diseases related to impaired circulation of cerebrospinal fluid circulation (CSF). Methods: In 2020, three patients with subarachnoid aneurysmal hemorrhage underwent insertion of an EVD navigation percutaneous stereotaxic device. Three cases introduced. Results: In all cases, satisfactory EVD functioning was noted during the surgery and during the early postoperative period. The EVD insertion procedure took an average of 10 min. The EVD insertion route calculations using the software took about 5–15 min. No cases showed any infection, hemorrhagic complications, or EVD dysfunction. According to the control brain computed tomography data, the catheter position was satisfactory and corresponded to the target coordinates in all cases. Conclusion: The use of the device, with its high accuracy and efficiency, can reduce the incidence of unsatisfactory EVD implantation cases in patients with neurosurgical pathology.

15

Waller, Sophie E., Sarah Browning, and Elizabeth Pepper. "045 Primary cutibacterium acnes central nervous system infection causing focal seizures: an unusual presentation of a rare disease." Journal of Neurology, Neurosurgery & Psychiatry 90, e7 (July 2019): A15.2—A15. http://dx.doi.org/10.1136/jnnp-2019-anzan.40.

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IntroductionCutibacterium acnes is a Gram positive, anaerobic bacterium of low pathogenic potential that forms part of the normal cutaneous flora. Although most often identified as a contaminant in culture of microbiological specimens, it is commonly implicated in both postoperative wound and implantable device infection. Neurosurgical device infections secondary to C. acnes are well recognised and are likely secondary to bacterial contamination from the skin during surgery. Indolent infection characterised by delayed presentation of weeks to months following intervention is common. C. acnes infection involving the central nervous system (CNS) in the absence of previous neurosurgical intervention is rare, but has been described following dental or mastoid infections and following facial trauma. A further case series has reported de novo C. acnes CNS infection occurring in the absence of these recognised risk factors, but with clinical features of meningitis being common to all.Methods and resultsWe describe a unique case of primary C. acnes extra-dural collection in a previously well patient with no neurosurgical history presenting with sub-acute focal seizures and progressive focal leptomeningeal thickening on MRI.ConclusionC. acnes CNS infection can occur in the immunocompetent and in the absence of neurosurgical intervention.

16

Davidson, Robin I., and Cyril Rodgers. "Right-angle partially compressible hemostatic clip applier." Journal of Neurosurgery 81, no. 5 (November 1994): 799. http://dx.doi.org/10.3171/jns.1994.81.5.0799.

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✓ A modification of a hemostatic clip applier is described that can apply clips at right angles to the plane of the handles. This device may be particularly useful in certain neurosurgical settings where use of the conventional clip applier is difficult. This device also prevents overcompression of clips.

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Svrmos, Nikolaos, Vasilios Valadakis, Konstantinos Grigoriou, Stefanos Patiakas, and Dimitrios Arvanitakis. "Intravascular Device-related Infections in Neurosurgical Patients: Incidence and Predictors." International Journal of Infectious Diseases 12 (June 2008): S44. http://dx.doi.org/10.1016/s1201-9712(08)60108-3.

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18

Papadopoulos, Stephen M., and John E. McGillicuddy. "A Simple Device for Controlling Suction Force in Neurosurgical Operations." Neurosurgery 25, no. 4 (October 1989): 662–63. http://dx.doi.org/10.1227/00006123-198910000-00029.

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19

Wong, Judith M., John E. Ziewacz, Jaykar R. Panchmatia, Angela M. Bader, Aditya S. Pandey, B. Gregory Thompson, Kai Frerichs, and Atul A. Gawande. "Patterns in neurosurgical adverse events: endovascular neurosurgery." Neurosurgical Focus 33, no. 5 (November 2012): E14. http://dx.doi.org/10.3171/2012.7.focus12180.

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As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in endovascular neurosurgery concerning the frequency of adverse events in practice, their patterns, and current methods of reducing the occurrence of these events. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice. Based on a review of the literature, thromboembolic events appeared to be the most common adverse events in endovascular neurosurgery, with a reported incidence ranging from 2% to 61% depending on aneurysm rupture status and mode of detection of the event. Intraprocedural and periprocedural prevention and rescue regimens are advocated to minimize this risk; however, evidence on the optimal use of anticoagulant and antithrombotic agents is limited. Furthermore, it is unknown what proportion of eligible patients receive any prophylactic treatment. Groin-site hematoma is the most common access-related complication. Data from the cardiac literature indicate an overall incidence of 9% to 32%, but data specific to neuroendovascular therapy are scant. Manual compression, compression adjuncts, and closure devices are used with varying rates of success, but no standardized protocols have been tested on a broad scale. Contrast-induced nephropathy is one of the more common causes of hospital-acquired renal insufficiency, with an incidence of 30% in high-risk patients after contrast administration. Evidence from medical fields supports the use of various preventive strategies. Intraprocedural vessel rupture is infrequent, with the reported incidence ranging from 1% to 9%, but it is potentially devastating. Improvements in device technology combined with proper endovascular technique play an important role in reducing this risk. Occasionally, anatomical or technical difficulties preclude treatment of the lesion of interest. Reports of such occurrences are scant, but existing series suggest an incidence of 4% to 6%. Management strategies for radiation-induced effects are also discussed. The incidence rates are unknown, but protective techniques have been demonstrated. Many of these complications have strategies that appear effective in reducing their risk of occurrence, but development and evaluation of systematic guidelines and protocols have been widely lacking. Furthermore, there has been little monitoring of levels of adherence to potentially effective practices. Protocols and monitoring programs to support integrated implementation may be broadly effective.

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Deng, Zhi-De, Bruce Luber, Nicholas L. Balderston, Melbaliz Velez Afanador, Michelle M. Noh, Jeena Thomas, William C. Altekruse, Shannon L. Exley, Shriya Awasthi, and Sarah H. Lisanby. "Device-Based Modulation of Neurocircuits as a Therapeutic for Psychiatric Disorders." Annual Review of Pharmacology and Toxicology 60, no. 1 (January 6, 2020): 591–614. http://dx.doi.org/10.1146/annurev-pharmtox-010919-023253.

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Device-based neuromodulation of brain circuits is emerging as a promising new approach in the study and treatment of psychiatric disorders. This work presents recent advances in the development of tools for identifying neurocircuits as therapeutic targets and in tools for modulating neurocircuits. We review clinical evidence for the therapeutic efficacy of circuit modulation with a range of brain stimulation approaches, including subthreshold, subconvulsive, convulsive, and neurosurgical techniques. We further discuss strategies for enhancing the precision and efficacy of neuromodulatory techniques. Finally, we survey cutting-edge research in therapeutic circuit modulation using novel paradigms and next-generation devices.

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Kotecha, Rupesh, Camille A. Berriochoa, Erin S. Murphy, Andre G. Machado, Samuel T. Chao, John H. Suh, and Kevin L. Stephans. "Report of whole-brain radiation therapy in a patient with an implanted deep brain stimulator: important neurosurgical considerations and radiotherapy practice principles." Journal of Neurosurgery 124, no. 4 (April 2016): 966–70. http://dx.doi.org/10.3171/2015.2.jns142951.

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Patients with implanted neuromodulation devices present potential challenges for radiation therapy treatment planning and delivery. Although guidelines exist regarding the irradiation of cardiac pacemakers and defibrillators, fewer data and less clinical experience exist regarding the effects of radiation therapy on less frequently used devices, such as deep brain stimulators. A 79-year-old woman with a history of coarse tremors effectively managed with deep brain stimulation presented with multiple intracranial metastases from a newly diagnosed lung cancer and was referred for whole-brain radiation therapy. She was treated with a German helmet technique to a total dose of 30 Gy in 10 fractions using 6 MV photons via opposed lateral fields with the neurostimulator turned off prior to delivery of each fraction. The patient tolerated the treatment well with no acute complications and no apparent change in the functionality of her neurostimulator device or effect on her underlying neuromuscular disorder. This represents the first reported case of the safe delivery of whole-brain radiation therapy in a patient with an implanted neurostimulator device. In cases such as this, neurosurgeons and radiation oncologists should have discussions with patients about the risks of brain injury, device malfunction or failure of the device, and plans for rigorous testing of the device before and after radiation therapy.

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ADACHI, Kazuhiko, Keitaro SHOJI, Atsushi FUJITA, and Eiji KOMURA. "8D24 Development and Evaluation of Neurosurgical Training System using Haptic Device." Proceedings of the Bioengineering Conference Annual Meeting of BED/JSME 2012.24 (2012): _8D24–1_—_8D24–2_. http://dx.doi.org/10.1299/jsmebio.2012.24._8d24-1_.

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Taniguchi, Hiroki, Hiroshi Iseki, Yoshihiro Muragaki, and Kitomo Takakura. "Development of coordinate system of stereotactic neurosurgical device for intraoperative MRI." International Congress Series 1268 (June 2004): 1287. http://dx.doi.org/10.1016/j.ics.2004.03.366.

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Arya, Sruja, Megan M. Filkowski, Pranav Nanda, and Sameer A. Sheth. "Deep brain stimulation for obsessive-compulsive disorder." Bulletin of the Menninger Clinic 83, no. 1 (March 2019): 84–96. http://dx.doi.org/10.1521/bumc.2019.83.1.84.

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Neurosurgical interventions have been used for decades to treat severe, refractory obsessive-compulsive disorder (OCD). Deep brain stimulation (DBS) is a neurosurgical procedure that is used routinely to treat movement disorders such as Parkinson's disease and essential tremor. Over the past two decades, DBS has been applied to OCD, building on earlier experience with lesional procedures. Promising results led to Humanitarian Device Exemption (HDE) approval of the therapy from the United States Food and Drug Administration in 2009. In this review, the authors describe the development of DBS for OCD, the most recent outcome data, and areas for future research.

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Tavakoli, Samon, Geoffrey Peitz, William Ares, Shaheryar Hafeez, and Ramesh Grandhi. "Complications of invasive intracranial pressure monitoring devices in neurocritical care." Neurosurgical Focus 43, no. 5 (November 2017): E6. http://dx.doi.org/10.3171/2017.8.focus17450.

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Intracranial pressure monitoring devices have become the standard of care for the management of patients with pathologies associated with intracranial hypertension. Given the importance of invasive intracranial monitoring devices in the modern neurointensive care setting, gaining a thorough understanding of the potential complications related to device placement—and misplacement—is crucial. The increased prevalence of intracranial pressure monitoring as a management tool for neurosurgical patients has led to the publication of a plethora of papers regarding their indications and complications. The authors aim to provide a concise review of key contemporary articles in the literature concerning important complications with the hope of elucidating practices that improve outcomes for neurocritically ill patients.

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Nagulic, M., Z. Ivanovic, I. Nikolic, Dj Alempijevic, and D. Dunjic. "Laboratorijski multipozicioni drzac baze lobanje." Acta chirurgica Iugoslavica 55, no. 1 (2008): 119–21. http://dx.doi.org/10.2298/aci0801119n.

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Authors present an original multipositional holder for skull base cadaveric specimens, either formalin or fresh. It is constructed to be fixated for standard neurosurgical operating table, devoted for laboratory micro neurosurgical dissection and suitable for simulation operation on patient. The holder is made of solid stainless steel, practical and easy for cleaning. The device permits good tree point?s fixation, extensive angular mobility of the primary and secondary joints, that the skull base specimen can be placed and supported in any desired position. It fulfills demands for fixation from external skull base surface with thin needles ensuring full surgical dissection field without obstacles or invisible angles.

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KOBAYASHI, Osuke, Kazuhiko ADACHI, Yu HASEGAWA, Atushi FUJITA, and Eiji KOHMURA. "642 Study for development of a neurosurgical training system using haptic device." Proceedings of the Dynamics & Design Conference 2010 (2010): _642–1_—_642–6_. http://dx.doi.org/10.1299/jsmedmc.2010._642-1_.

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Ludvig, Nandor, Geza Medveczky, Jacqueline A. French, Chad Carlson, Orrin Devinsky, and Ruben I. Kuzniecky. "Evolution and Prospects for Intracranial Pharmacotherapy for Refractory Epilepsies: The Subdural Hybrid Neuroprosthesis." Epilepsy Research and Treatment 2010 (February 8, 2010): 1–10. http://dx.doi.org/10.1155/2010/725696.

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Intracranial pharmacotherapy is a novel strategy to treat drug refractory, localization-related epilepsies not amenable to resective surgery. The common feature of the method is the use of some type of antiepileptic drug (AED) delivery device placed inside the cranium to prevent or stop focal seizures. This distinguishes it from other nonconventional methods, such as intrathecal pharmacotherapy, electrical neurostimulation, gene therapy, cell transplantation, and local cooling. AED-delivery systems comprise drug releasing polymers and neuroprosthetic devices that can deliver AEDs into the brain via intraparenchymal, ventricular, or transmeningeal routes. One such device is the subdural Hybrid Neuroprosthesis (HNP), designed to deliver AEDs, such as muscimol, into the subdural/subarachnoid space overlaying neocortical epileptogenic zones, with electrophysiological feedback from the treated tissue. The idea of intracranial pharmacotherapy and HNP treatment for epilepsy originated from multiple sources, including the advent of implanted medical devices, safety data for intracranial electrodes and catheters, evidence for the seizure-controlling efficacy of intracerebral AEDs, and further understanding of the pathophysiology of focal epilepsy. Successful introduction of intracranial pharmacotherapy into clinical practice depends on how the intertwined scientific, engineering, clinical, neurosurgical and regulatory challenges will be met to produce an effective and commercially viable device.

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Mahat, Roshani, Amita Moktan, Sanskriti Thapa, Ranju Devkota, Pravesh Rajbhandari, and Basant Pant. "Caring of Neurosurgical Patients with External Ventricular Drain." Annapurna Journal of Health Sciences 1, no. 2 (August 8, 2021): 73–75. http://dx.doi.org/10.52910/ajhs.50.

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An external ventricular drain (EVD), also known as a ventriculostomy or extraventricular drain, is a device used in neurosurgery to treat hydrocephalus which can lead to raised intracranial pressure when the normal flow of cerebrospinal fluid (CSF) inside the brain is obstructed. An EVD is a flexible plastic catheter placed by a neurosurgeon or neurointensivist and managed by intensive care unit (ICU) physicians and nurses. The purpose of external ventricular drainage is to divert fluid from the ventricles of the brain and allow for monitoring of intracranial pressure Nurses are responsible for the care of patients who have external ventricular drains. This article explains how the drains work and discusses key nursing considerations for their management

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Neidert, Nicolas, Jakob Straehle, Daniel Erny, Vlad Sacalean, Amir El Rahal, David Steybe, Rainer Schmelzeisen, et al. "Stimulated Raman histology in the neurosurgical workflow of a major European neurosurgical center — part A." Neurosurgical Review 45, no. 2 (December 16, 2021): 1731–39. http://dx.doi.org/10.1007/s10143-021-01712-0.

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AbstractHistopathological diagnosis is the current standard for the classification of brain and spine tumors. Raman spectroscopy has been reported to allow fast and easy intraoperative tissue analysis. Here, we report data on the intraoperative implementation of a stimulated Raman histology (SRH) as an innovative strategy offering intraoperative near real-time histopathological analysis. A total of 429 SRH images from 108 patients were generated and analyzed by using a Raman imaging system (Invenio Imaging Inc.). We aimed at establishing a dedicated workflow for SRH serving as an intraoperative diagnostic, research, and quality control tool in the neurosurgical operating room (OR). First experiences with this novel imaging modality were reported and analyzed suggesting process optimization regarding tissue collection, preparation, and imaging. The Raman imaging system was rapidly integrated into the surgical workflow of a large neurosurgical center. Within a few minutes of connecting the device, the first high-quality images could be acquired in a “plug-and-play” manner. We did not encounter relevant obstacles and the learning curve was steep. However, certain prerequisites regarding quality and acquisition of tissue samples, data processing and interpretation, and high throughput adaptions must be considered. Intraoperative SRH can easily be integrated into the workflow of neurosurgical tumor resection. Considering few process optimizations that can be implemented rapidly, high-quality images can be obtained near real time. Hence, we propose SRH as a complementary tool for the diagnosis of tumor entity, analysis of tumor infiltration zones, online quality and safety control and as a research tool in the neurosurgical OR.

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Vergouwen, Mervyn DI, Gabriel JE Rinkel, Ale Algra, Jens Fiehler, Helmuth Steinmetz, Peter Vajkoczy, Frans H. Rutten, Steffen Luntz, Daniel Hänggi, and Nima Etminan. "Prospective Randomized Open-label Trial to evaluate risk faCTor management in patients with Unruptured intracranial aneurysms: Study protocol." International Journal of Stroke 13, no. 9 (July 18, 2018): 992–98. http://dx.doi.org/10.1177/1747493018790033.

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Rationale Unruptured intracranial aneurysms are currently left untreated if the presumed complication risk of preventive endovascular or neurosurgical intervention is higher than the risk of rupture. Aneurysm wall inflammation and blood pressure are attractive modifiable risk factors of aneurysm rupture and growth. Aim To investigate in patients with an unruptured intracranial aneurysm who do not qualify for preventive endovascular or neurosurgical intervention whether a treatment strategy of acetylsalicylic acid 100 mg/day plus intensive blood pressure treatment (targeted systolic blood pressure < 120 mmHg, monitored with a home blood pressure measuring device) reduces the risk of aneurysm rupture or growth compared with care as usual (no acetylsalicylic acid, targeted office systolic blood pressure < 140 mmHg, no home blood pressure measuring device). Sample size We aim to randomize 776 patients 1:1 to the intervention arm or care as usual. Design Bi-national (Germany and the Netherlands) multicenter, prospective, randomized, open-label phase III trial with blinded outcome assessment. Outcomes The primary outcome is aneurysm rupture or growth (increase in any aneurysm diameter by ≥ 1 mm) on repeated MR or CT angiography within 36 ± 6 months after randomization. Discussion The Prospective Randomized Open-label Trial to Evaluate risk faCTor management in patients with Unruptured intracranial aneurysms (PROTECT-U) is the first randomized trial to investigate if a medical strategy reduces the risk of rupture or growth of intracranial aneurysms in patients not undergoing preventive endovascular or neurosurgical aneurysm treatment. Clinical trial Registration: NCT03063541.

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Roethe, Anna L., Philipp Landgraf, Torsten Schröder, Martin Misch, Peter Vajkoczy, and Thomas Picht. "Monitor-based exoscopic 3D4k neurosurgical interventions: a two-phase prospective-randomized clinical evaluation of a novel hybrid device." Acta Neurochirurgica 162, no. 12 (May 19, 2020): 2949–61. http://dx.doi.org/10.1007/s00701-020-04361-2.

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Abstract Background Promoting a disruptive innovation in microsurgery, exoscopes promise alleviation of physical strain and improved image quality through digital visualization during microneurosurgical interventions. This study investigates the impact of a novel 3D4k hybrid exoscope (i.e., combining digital and optical visualization) on surgical performance and team workflow in preclinical and clinical neurosurgical settings. Methods A pre-clinical workshop setting has been developed to assess usability and implementability through skill-based scenarios (neurosurgical participants n = 12). An intraoperative exploration in head and spine surgery (n = 9) and a randomized clinical study comparing ocular and monitor mode in supratentorial brain tumor cases (n = 20) followed within 12 months. Setup, procedure, case characteristics, surgical performance, and user experience have been analyzed for both ocular group (OG) and monitor group (MG). Results Brain tumor cases using frontal, frontoparietal, or temporal approaches have been identified as favorable use cases for introducing exoscopic neurosurgery. Mean monitor distance and angle were 180 cm and 10°. Surgical ergonomics when sitting improved significantly in MG compared with OG (P = .03). Hand-eye coordination required familiarization in MG. Preclinical data showed a positive correlation between lateral camera inclination and impact on hand-eye coordination (rs = 0.756, P = .01). There was no significant added surgical time in MG. Image quality in current generation 3D4k monitors has been rated inferior to optic visualization yet awaits updates. Conclusions The hybrid exoscopic device can be integrated into established neurosurgical workflows. Currently, exoscopic interventions seem most suited for cranial tumor surgery in lesions that are not deep-seated. Ergonomics improve in monitor mode compared to conventional microsurgery.

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Marcus, Hani J., Archie Hughes-Hallett, Richard M. Kwasnicki, Ara Darzi, Guang-Zhong Yang, and Dipankar Nandi. "Technological innovation in neurosurgery: a quantitative study." Journal of Neurosurgery 123, no. 1 (July 2015): 174–81. http://dx.doi.org/10.3171/2014.12.jns141422.

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OBJECT Technological innovation within health care may be defined as the introduction of a new technology that initiates a change in clinical practice. Neurosurgery is a particularly technology-intensive surgical discipline, and new technologies have preceded many of the major advances in operative neurosurgical techniques. The aim of the present study was to quantitatively evaluate technological innovation in neurosurgery using patents and peer-reviewed publications as metrics of technology development and clinical translation, respectively. METHODS The authors searched a patent database for articles published between 1960 and 2010 using the Boolean search term “neurosurgeon OR neurosurgical OR neurosurgery.” The top 50 performing patent codes were then grouped into technology clusters. Patent and publication growth curves were then generated for these technology clusters. A top-performing technology cluster was then selected as an exemplar for a more detailed analysis of individual patents. RESULTS In all, 11,672 patents and 208,203 publications related to neurosurgery were identified. The top-performing technology clusters during these 50 years were image-guidance devices, clinical neurophysiology devices, neuromodulation devices, operating microscopes, and endoscopes. In relation to image-guidance and neuromodulation devices, the authors found a highly correlated rapid rise in the numbers of patents and publications, which suggests that these are areas of technology expansion. An in-depth analysis of neuromodulation-device patents revealed that the majority of well-performing patents were related to deep brain stimulation. CONCLUSIONS Patent and publication data may be used to quantitatively evaluate technological innovation in neurosurgery.

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Yavas, Gorkem, Kadri Emre Caliskan, and Mehmet Sedat Cagli. "Three-dimensional–printed marker–based augmented reality neuronavigation: a new neuronavigation technique." Neurosurgical Focus 51, no. 2 (August 2021): E20. http://dx.doi.org/10.3171/2021.5.focus21206.

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OBJECTIVE The aim of this study was to assess the precision and feasibility of 3D-printed marker–based augmented reality (AR) neurosurgical navigation and its use intraoperatively compared with optical tracking neuronavigation systems (OTNSs). METHODS Three-dimensional–printed markers for CT and MRI and intraoperative use were applied with mobile devices using an AR light detection and ranging (LIDAR) camera. The 3D segmentations of intracranial tumors were created with CT and MR images, and preoperative registration of the marker and pathology was performed. A patient-specific, surgeon-facilitated mobile application was developed, and a mobile device camera was used for neuronavigation with high accuracy, ease, and cost-effectiveness. After accuracy values were preliminarily assessed, this technique was used intraoperatively in 8 patients. RESULTS The mobile device LIDAR camera was found to successfully overlay images of virtual tumor segmentations according to the position of a 3D-printed marker. The targeting error that was measured ranged from 0.5 to 3.5 mm (mean 1.70 ± 1.02 mm, median 1.58 mm). The mean preoperative preparation time was 35.7 ± 5.56 minutes, which is longer than that for routine OTNSs, but the amount of time required for preoperative registration and the placement of the intraoperative marker was very brief compared with other neurosurgical navigation systems (mean 1.02 ± 0.3 minutes). CONCLUSIONS The 3D-printed marker–based AR neuronavigation system was a clinically feasible, highly precise, low-cost, and easy-to-use navigation technique. Three-dimensional segmentation of intracranial tumors was targeted on the brain and was clearly visualized from the skin incision to the end of surgery.

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Piek, Juergen, Joachim Oertel, and Michael Robert Gaab. "Waterjet dissection in neurosurgical procedures: clinical results in 35 patients." Journal of Neurosurgery 96, no. 4 (April 2002): 690–96. http://dx.doi.org/10.3171/jns.2002.96.4.0690.

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Object. Waterjet dissection represents a new minimally traumatic surgical method for dissection that can be used in various parenchymal organs, in which it allows highly precise parenchymal dissection while preserving blood vessels, resulting in reduced intraoperative blood loss. This study was performed to investigate the clinical application of this new technique in neurosurgical procedures, such as brain tumor resection and epilepsy surgery. Methods. Thirty-four patients with gliomas (Grades II–IV), cerebral metastases, temporal lobe epilepsy, or cerebellar hemangioblastomas, and one patient with internal carotid artery (ICA) stenosis were treated surgically with the aid of the waterjet. Resection was performed using waterjet dissection in combination with conventional neurosurgical procedures. Intraoperatively, the waterjet was easy to handle, and no complications due to the device were observed. Dissection of tissue was possible for all pathological conditions, and pressures between 3 and 45 bars were used. In gliomas, metastases, epilepsy surgery, and hemangioblastoma, the tissue was dissected at pressures between 3 and 17 bars, which preserved blood vessels. Dissection of meningiomas and the ICA stenosis required higher pressures (between 20 and 45 bars); with these pressures, blood vessels were also dissected. Conclusions. These results indicate that the waterjet dissection procedure can be used intraoperatively without complications. This device appears to be particularly suitable for the dissection of highly vascularized gliomas or normal brain tissue, in which tissue dissection with sparing of blood vessels can be achieved. To prove that this is a useful addition to the neurosurgical armamentarium, reduction of blood loss or postoperative brain edema compared with conventional methods should be demonstrated in future studies.

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Perin, Alessandro, Francesco Ugo Prada, Michela Moraldo, Andrea Schiappacasse, Tommaso Francesco Galbiati, Enrico Gambatesa, Piergiorgio d’Orio, et al. "USim: A New Device and App for Case-Specific, Intraoperative Ultrasound Simulation and Rehearsal in Neurosurgery. A Preliminary Study." Operative Neurosurgery 14, no. 5 (June 29, 2017): 572–78. http://dx.doi.org/10.1093/ons/opx144.

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Abstract BACKGROUND Intraoperative ultrasound (iUS) is an excellent aid for neurosurgeons to perform better and safer operations thanks to real time, continuous, and high-quality intraoperative visualization. OBJECTIVE To develop an innovative training method to teach how to perform iUS in neurosurgery. METHODS Patients undergoing surgery for different brain or spine lesions were iUS scanned (before opening the dura) in order to arrange a collection of 3-dimensional, US images; this set of data was matched and paired to preoperatively acquired magnetic resonance images in order to create a library of neurosurgical cases to be studied offline for training and rehearsal purposes. This new iUS training approach was preliminarily tested on 14 European neurosurgery residents, who participated at the 2016 European Association of Neurosurgical Societies Training Course (Sofia, Bulgaria). RESULTS USim was developed by Camelot and the Besta NeuroSim Center as a dedicated app that transforms any smartphone into a “virtual US probe,” in order to simulate iUS applied to neurosurgery on a series of anonymized, patient-specific cases of different central nervous system tumors (eg, gliomas, metastases, meningiomas) for education, simulation, and rehearsal purposes. USim proved to be easy to use and allowed residents to quickly learn to handle a US probe and interpret iUS semiotics. CONCLUSION USim could help neurosurgeons learn neurosurgical iUS safely. Furthermore, neurosurgeons could simulate many cases, of different brain/spinal cord tumors, that resemble the specific cases they have to operate on. Finally, the library of cases would be continuously updated, upgraded, and made available to neurosurgeons.

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Graziano, Francesca, Rosario Maugeri, G. Roberto Giammalva, Giovanni Zabbia, and Domenico G. Iacopino. "Novel Application of Pulsed Radiofrequency Energy Device (PEAK Plasmablade) in Neurosurgical Reconstructive Surgery." World Neurosurgery 116 (August 2018): 472–73. http://dx.doi.org/10.1016/j.wneu.2018.03.039.

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Huang, Felicia Scaggs, Andrea Ankrum, Cincinnati Hospital, Zheyi Teoh, Joshua Courter, Francesco, Mangano, Karin Bierbrauer, and Josh. "Learnings from a Cutibacterium acnes pseudo-outbreak in pediatric neurosurgical patients." Antimicrobial Stewardship & Healthcare Epidemiology 2, S1 (May 16, 2022): s57—s58. http://dx.doi.org/10.1017/ash.2022.166.

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Background:Cutibacterium acnes is normal skin flora as well as a common culture contaminant. It can cause infections in the setting of sterile implants, although clinical presentations can be subtle. Differentiating true infection from sample contamination is challenging and has implications for patient care. We describe an investigation of a cluster of 7 hospitalized pediatric patients with C. acnes isolated from anaerobic cultures of cerebrospinal fluid (CSF) over 3 weeks at a quaternary-care children’s hospital. Methods: An outbreak response was coordinated between the infection prevention and control (IPC), microbiology, and neurosurgery teams. We defined a case as a hospitalized patient with C. acnes isolated from a CSF culture beginning in November 2020. We reviewed charts of all cases and CSF culture collection on all case units, transport to and processing at the microbiology laboratory, and the IPC team measured adherence for all processes. Results: There were 8 positive cultures in 7 cases from November 10 to 27, 2020. The median case age was 2 months (range, 0–119). Cases occurred on 4 different units. All positive patients had at least 1 implanted neurosurgical device used for CSF drainage. There were no clear commonalities in surgeon responsible for device placement, hardware type placed, or staff collecting CSF samples. A standard protocol for CSF collection was followed for all cases. Overall, 3 patients cleared cultures without intervention, 2 received oral antibiotics, and 2 underwent surgical removal of their device. Specimen processing was unchanged, although due to supply issues, an alternative anaerobic culture media (Anaerobic Systems, Morgan Hills, CA) was used for 6 weeks, during which all cases were identified. Compared to routine media, the alternative is known to enhance organism detection. The company reported no concerns for media contamination or C. acnes outbreaks. Once routine media became available, CSF culture positivity for C. acnes returned to baseline (late November or early December) (Fig. 1). Conclusions: We identified a likely pseudo-outbreak related to temporary use of a more sensitive culture media. No direct patient harm was identified, although many had increased risk of harm by surgical intervention or prolonged length of stay. Technological advances may enhance organism identification but challenge existing paradigms of care. More studies are needed to better delineate the intersection of diagnostic advancements with patient care standards.Funding: NoneDisclosures: None

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Tan, Kim K., Robert Grzeszczuk, David N. Levin, Charles A. Pelizzari, George T. Y. Chen, Robert K. Erickson, Douglas Johnson, and George J. Dohrmann. "A frameless stereotactic approach to neurosurgical planning based on retrospective patient-image registration." Journal of Neurosurgery 79, no. 2 (August 1993): 296–303. http://dx.doi.org/10.3171/jns.1993.79.2.0296.

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✓ A frameless stereotactic device interfacing an electromagnetic three-dimensional (3-D) digitizer to a computer workstation is described. The patient-image coordinate transformation was found by retrospectively registering a digitizer-derived model of the patient's scalp with a magnetic resonance (MR) imaging-derived model of the same surface. This procedure was performed with routine imaging data, eliminating the need to obtain special-purpose MR images with fiducial markers in place. After patient-image fusion was achieved, a hand-held digitizing stylus was moved over the scalp and tracked in real time on cross-sectional and 3-D brain images on the computer screen. This device was used for presurgical localization of lesions in 10 patients with meningeal and superficial brain tumors. The results suggest that the system is accurate enough (typical error range 3 to 8 mm) to enable the surgeon to reduce the craniotomy to one-half the size advisable with conventional qualitative presurgical planning.

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Minchev, Georgi, Gernot Kronreif, Mauricio Martínez-Moreno, Christian Dorfer, Alexander Micko, Aygül Mert, Barbara Kiesel, Georg Widhalm, Engelbert Knosp, and Stefan Wolfsberger. "A novel miniature robotic guidance device for stereotactic neurosurgical interventions: preliminary experience with the iSYS1 robot." Journal of Neurosurgery 126, no. 3 (March 2017): 985–96. http://dx.doi.org/10.3171/2016.1.jns152005.

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OBJECTIVE Robotic devices have recently been introduced in stereotactic neurosurgery in order to overcome the limitations of frame-based and frameless techniques in terms of accuracy and safety. The aim of this study is to evaluate the feasibility and accuracy of the novel, miniature, iSYS1 robotic guidance device in stereotactic neurosurgery. METHODS A preclinical phantom trial was conducted to compare the accuracy and duration of needle positioning between the robotic and manual technique in 162 cadaver biopsies. Second, 25 consecutive cases of tumor biopsies and intracranial catheter placements were performed with robotic guidance to evaluate the feasibility, accuracy, and duration of system setup and application in a clinical setting. RESULTS The preclinical phantom trial revealed a mean target error of 0.6 mm (range 0.1–0.9 mm) for robotic guidance versus 1.2 mm (range 0.1–2.6 mm) for manual positioning of the biopsy needle (p < 0.001). The mean duration was 2.6 minutes (range 1.3–5.5 minutes) with robotic guidance versus 3.7 minutes (range 2.0–10.5 minutes) with manual positioning (p < 0.001). Clinical application of the iSYS1 robotic guidance device was feasible in all but 1 case. The median real target error was 1.3 mm (range 0.2–2.6 mm) at entry and 0.9 mm (range 0.0–3.1 mm) at the target point. The median setup and instrument positioning times were 11.8 minutes (range 4.2–26.7 minutes) and 4.9 minutes (range 3.1–14.0 minutes), respectively. CONCLUSIONS According to the preclinical data, application of the iSYS1 robot can significantly improve accuracy and reduce instrument positioning time. During clinical application, the robot proved its high accuracy, short setup time, and short instrument positioning time, as well as demonstrating a short learning curve.

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Caliskan, Kadri Emre, Gorkem Yavas, and Mehmet Sedat Cagli. "Intraoperative mixed-reality spinal neuronavigation system: a novel navigation technique for spinal intradural pathologies." Neurosurgical Focus 56, no. 1 (January 2024): E2. http://dx.doi.org/10.3171/2023.10.focus23624.

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OBJECTIVE The objective of this study was to assess the intraoperative accuracy and feasibility of 3D-printed marker-based mixed-reality neurosurgical navigation for spinal intradural pathologies. METHODS The authors produced 3D segmentations of spinal intradural tumors with neighboring structures by using combined CT and MRI, and preoperative registration of pathology and markers was successfully performed. A patient-specific, surgeon-facilitated application for mobile devices was built, and a mixed-reality light detection and ranging (LIDAR) camera on a mobile device was employed for cost-effective, high-accuracy spinal neuronavigation. RESULTS Mobile device LIDAR cameras can successfully overlay images of virtual tumor segmentations according to the position of a 3D-printed marker. The surgeon can visualize and manipulate 3D segmentations of the pathology intraoperatively in 3D. CONCLUSIONS A 3D-printed marker-based mixed-reality spinal neuronavigation technique was performed in spinal intradural pathology procedures and has potential to be clinically feasible and easy to use for surgeons, as well as being time saving, cost-effective, and highly precise for spinal surgical procedures.

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HASEGAWA, Yu, Kazuhiko ADACHI, Youhei AZUMA, Atushi FUJITA, and Eiji KOUMURA. "352 A feasibility study for development of a neurosurgical training system using haptic device." Proceedings of the Dynamics & Design Conference 2008 (2008): _352–1_—_352–6_. http://dx.doi.org/10.1299/jsmedmc.2008._352-1_.

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ADACHI, Kazuhiko, Keitaro SHOJI, Takahiro KURIMOTO, Atsushi FUJITA, and Eiji KOHMURA. "629 Visual improvement of simulated surgical field of neurosurgical training system using haptic device." Proceedings of Conference of Kansai Branch 2012.87 (2012): _6–26_. http://dx.doi.org/10.1299/jsmekansai.2012.87._6-26_.

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Schulder, Michael, Danny Liang, and Peter W. Carmel. "Cranial surgery navigation aided by a compact intraoperative magnetic resonance imager." Journal of Neurosurgery 94, no. 6 (June 2001): 936–45. http://dx.doi.org/10.3171/jns.2001.94.6.0936.

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Object. In this article the authors report on a novel, compact device for magnetic resonance (MR) imaging that has been developed for use in a standard neurosurgical operating room. Methods. The device includes a permanent magnet with a field strength of 0.12 tesla. The poles of the magnet are vertically aligned, with a gap of 25 cm. When not in use the magnet is stored in a shielded cage in a corner of the operating room; it is easily moved into position and attaches to a regular operating table. The magnet is raised for imaging when needed and may be lowered to allow surgery to proceed unencumbered. Surgical navigation with optical and/or magnetic probes is incorporated into the system. Twenty-five patients have undergone removal of intracranial lesions with the aid of this device. Operations included craniotomy for tumor or other lesion in 18 patients and transsphenoidal resection of tumor in seven. The number of scans ranged from two to five per surgery (average 3.4); image quality was excellent in 45%, adequate in 43%, and poor in 12%. In four patients MR imaging revealed additional tumor that was then resected; in five others visual examination of the operative field was inconclusive but complete tumor removal was confirmed on MR imaging. In 21 patients early postoperative diagnostic MR studies corroborated the findings on the final intraoperative MR image. Using a water-covered phantom, the accuracy of the navigational tools was assessed; 120 data points were measured. The accuracy of the magnetic probe averaged 1.3 mm and 2.1 mm in the coronal and axial planes, respectively; the optical probe accuracy was 2.1 mm and 1.8 mm in those planes. Conclusions. This device provides high-quality intraoperative imaging and accurate surgical navigation with minimal disruption in a standard neurosurgical operating room.

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Pérez-Martín, Ester, Almudena Coto-Vilcapoma, Juan Castilla-Silgado, María Rodríguez-Cañón, Catuxa Prado, Gabriel Álvarez, Marco Antonio Álvarez-Vega, Benjamín Fernández-García, Manuel Menéndez-González, and Cristina Tomás-Zapico. "Refining Stereotaxic Neurosurgery Techniques and Welfare Assessment for Long-Term Intracerebroventricular Device Implantation in Rodents." Animals 13, no. 16 (August 14, 2023): 2627. http://dx.doi.org/10.3390/ani13162627.

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Stereotaxic surgeries enable precise access to specific brain regions, being of particular interest for chronic intracerebroventricular drug delivery. However, the challenge of long-term studies at this level is to allow the implantation of drug storage devices and their correct intrathecal connection while guaranteeing animal welfare during the entire study period. In this study, we propose an optimized method for safe intrathecal device implantation, focusing on preoperative, intraoperative, and postoperative procedures, following the 3Rs principle and animal welfare regulations. Our optimized protocol introduces three main refinements. Firstly, we modify the dimensions of the implantable devices, notably diminishing the device-to-mouse weight ratio. Secondly, we use a combination of cyanoacrylate tissue adhesive and UV light-curing resin, which decreases surgery time, improves healing, and notably minimizes cannula detachment or adverse effects. Thirdly, we develop a customized welfare assessment scoresheet to accurately monitor animal well-being during long-term implantations. Taken together, these refinements positively impacted animal welfare by minimizing the negative effects on body weight, surgery-related complications, and anxiety-like behaviors. Overall, the proposed refinements have the potential to reduce animal use, enhance experimental data quality, and improve reproducibility. Additionally, these improvements can be extended to other neurosurgical techniques, thereby advancing neuroscience research, and benefiting the scientific community.

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Husain, Mazhar, Deepak K. Jha, Sunil Agrawal, Nuzhat Husain, and Rakesh K. Gupta. "Conical working tube: a special device for endoscopic surgery of herniated lumbar discs." Journal of Neurosurgery: Spine 2, no. 3 (March 2005): 265–70. http://dx.doi.org/10.3171/spi.2005.2.3.0265.

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Object. The instrumentation for endoscopic discectomy continues to evolve to allow for acceptable clinical outcomes and expanding applications. The authors describe their experience in using a conical working tube equipped with a guide for angular entry of the telescope to perform endoscopic discectomy in patients with lumbar disc herniation. Methods. Fifty-one patients (38 men and 13 women) with herniated lumbar discs underwent endoscopic lumbar surgery during the past 2.5 years at the authors' institutions. A conical working tube was inserted over sequential coaxial dilators via a muscle-splitting approach. Conventional neurosurgical instruments were used in conjunction with an angled insertion telescope. Endoscopic discectomy was performed at the L1–2 (one case), L3–4 (two cases), L4–5 (32 cases), and L5—S1 (18 cases) levels. The surgical approach was bilateral in two patients: bilateral L4–5 in one, and right L4–5 and left L5—S1 in the other. The remaining patient suffered adjacent two-level (right-sided L4–5 and L5—S1) herniations. Outcome was assessed at a mean of 11 months after surgery by using modified Macnab criteria. Outcomes were excellent in 46 (90%), fair in three (6%), and poor in two patients (4%). Complications occurred in four patients and included a dural tear in one case, postoperative neurological deterioration in two, and discitis in two; in two of these patients open surgical exploration was required. Conclusions. A separate angled entry of the telescope shortens the effective length of the working sheath and creates a better working space, thereby allowing greater instrument maneuverability and ability to use conventional neurosurgical instruments. In addition, use of this telescope in other endoscopic procedures reduces overall cost of instrumentation and treatment, and results are comparable to those reported in association with microscopic lumbar discectomy.

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V., Vikas, Aravind Reddy Voggu, Kirit Arumalla, Ronak Doshi, Aravind Ramkumar, Anita Mahadevan, and Madhav Rao. "Mythri 1.0—Progress of an Indian Surgical Robot." Indian Journal of Neurosurgery 9, no. 02 (August 2020): 095–98. http://dx.doi.org/10.1055/s-0040-1710108.

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AbstractNeurosurgical procedures are performed using operating microscopes. The technology of most microscopes has not changed much over the past 60 years. The National Institute of Mental Health and Neurosciences and International Institute of Information Technology based at Bengaluru have embarked on joint collaboration for developing robot for neurosurgical applications. As a working prototype, robotic microscope Mythri 1.0 has been developed. An overview of the development process, working, and features of the device is presented in the article.

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Dho, Yun-Sik, Sang Joon Park, Haneul Choi, Youngdeok Kim, Hyeong Cheol Moon, Kyung Min Kim, Ho Kang, et al. "Development of an inside-out augmented reality technique for neurosurgical navigation." Neurosurgical Focus 51, no. 2 (August 2021): E21. http://dx.doi.org/10.3171/2021.5.focus21184.

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OBJECTIVE With the advancement of 3D modeling techniques and visualization devices, augmented reality (AR)–based navigation (AR navigation) is being developed actively. The authors developed a pilot model of their newly developed inside-out tracking AR navigation system. METHODS The inside-out AR navigation technique was developed based on the visual inertial odometry (VIO) algorithm. The Quick Response (QR) marker was created and used for the image feature–detection algorithm. Inside-out AR navigation works through the steps of visualization device recognition, marker recognition, AR implementation, and registration within the running environment. A virtual 3D patient model for AR rendering and a 3D-printed patient model for validating registration accuracy were created. Inside-out tracking was used for the registration. The registration accuracy was validated by using intuitive, visualization, and quantitative methods for identifying coordinates by matching errors. Fine-tuning and opacity-adjustment functions were developed. RESULTS ARKit-based inside-out AR navigation was developed. The fiducial marker of the AR model and those of the 3D-printed patient model were correctly overlapped at all locations without errors. The tumor and anatomical structures of AR navigation and the tumors and structures placed in the intracranial space of the 3D-printed patient model precisely overlapped. The registration accuracy was quantified using coordinates, and the average moving errors of the x-axis and y-axis were 0.52 ± 0.35 and 0.05 ± 0.16 mm, respectively. The gradients from the x-axis and y-axis were 0.35° and 1.02°, respectively. Application of the fine-tuning and opacity-adjustment functions was proven by the videos. CONCLUSIONS The authors developed a novel inside-out tracking–based AR navigation system and validated its registration accuracy. This technical system could be applied in the novel navigation system for patient-specific neurosurgery.

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Jain, Swati, Yujia Gao, Tseng Tsai Yeo, and Kee Yuan Ngiam. "Use of Mixed Reality in Neuro-Oncology: A Single Centre Experience." Life 13, no. 2 (January 31, 2023): 398. http://dx.doi.org/10.3390/life13020398.

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(1) Background: Intra-operative neuronavigation is currently an essential component to most neurosurgical operations. Recent progress in mixed reality (MR) technology has attempted to overcome the disadvantages of the neuronavigation systems. We present our experience using the HoloLens 2 in neuro-oncology for both intra- and extra-axial tumours. (2) Results: We describe our experience with three patients who underwent tumour resection. We evaluated surgeon experience, accuracy of superimposed 3D image in tumour localisation with standard neuronavigation both pre- and intra-operatively. Surgeon training and usage for HoloLens 2 was short and easy. The process of image overlay was relatively straightforward for the three cases. Registration in prone position with a conventional neuronavigation system is often difficult, which was easily overcome during use of HoloLens 2. (3) Conclusion: Although certain limitations were identified, the authors feel that this system is a feasible alternative device for intra-operative visualization of neurosurgical pathology. Further studies are being planned to assess its accuracy and suitability across various surgical disciplines.

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Mansouri, Alireza, Benjamin Cooper, Samuel M. Shin, and Douglas Kondziolka. "Randomized controlled trials and neurosurgery: the ideal fit or should alternative methodologies be considered?" Journal of Neurosurgery 124, no. 2 (February 2016): 558–68. http://dx.doi.org/10.3171/2014.12.jns142465.

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OBJECT Randomized-controlled trials (RCTs) are advocated to provide high-level medical evidence. However, in neurosurgery, there are barriers to conducting RCTs. The authors of this study sought to analyze the quality of neurosurgical RCTs since 2000 to determine the adequacy of their design and reporting. METHODS A search of the MEDLINE and EMBASE databases (2000–2014) was conducted. The medical subject heading (MeSH) terms used in the search included: “neurosurgery” OR “neurosurgical procedure,” “brain neoplasms,” “infarction” and “decompression,” “carotid stenosis,” “cerebral hemorrhage,” and “spinal fusion.” These studies were limited to RCTs, in humans, and in the English language. The Consolidated Standards for Reporting of Trials (CONSORT) and Jadad scales were used to assess the quality of RCT design and reporting. The standardized median times cited (median citations divided by years since publication) were used to assess impact. A pragmatic-explanatory continuum indicator summary-based scale was used to assess the design of the studies as primarily pragmatic or explanatory. RESULTS Sixty-one articles were identified, and the following subspecialties were the most common: vascular (23, 37%), followed by functional neurosurgery and neurooncology (both 13, 21%). The following nations were the primary leaders in RCTs: US (25 studies, 41%), Germany (8 studies, 13%), and the United Kingdom (7 studies, 11%). Median sample size was 100 (interquartile range [IQR] 41.5–279). The majority of the studies (40, 66%) had pragmatic objectives. The median number of times cited overall was 69 (IQR 20.5–193). The combined median CONSORT score was 36 (IQR 27.5–39). Blinding was most deficiently reported. Other areas with a relatively low quality of reporting were sample size calculation (34.2% of surgical, 38.5% of drug, and 20% of device studies), allocation concealment (28.9% of surgical, 23.1% of drug, and 50% of device studies), and protocol implementation (18.4% of surgical, 23% of drug, and 20% of device studies). The quality of reporting did not correlate with the study impact. All studies had a median Jadad score ≤ 3. Thirty-three pragmatic studies (83%) and 5 explanatory studies (25%) met the design objectives. All pragmatic studies based on drug and device trials met their objectives, while 74% of pragmatic surgical trials met their objectives. CONCLUSIONS The prevalence of neurosurgical RCTs is low. The quality of RCT design and reporting in neurosurgery is also low. Many study designs are not compatible with stated objectives. Pragmatic studies were more likely to meet design objectives. Given the role of RCTs as one of the highest levels of evidence, it is critical to improve on their methodology and reporting.

Journal articles on the topic 'Neurosurgical device'

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