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| Neuronavigation | |
|---|---|
| MeSH | D038361 |
Neuronavigation is the set of computer-assisted technologies used by neurosurgeons to guide or "navigate" within the confines of the skull or vertebral column during surgery, and used by psychiatrists to accurately target rTMS (transcranial magnetic stimulation). The set of hardware for these purposes is referred to as a neuronavigator.
Neuronavigation is recognized as the next evolutionary step of stereotactic surgery, a set of techniques that dates back to the early 1900s and that gained popularity during the 1940s, particularly in Germany, France and the U.S., with the development of surgery for the treatment of movement disorders such as Parkinson's disease and dystonias. In its infancy the purpose of this technology was to create a mathematical model describing a proposed coordinate system for the space within a closed structure, e.g., the skull. This "fiducial spatial coordinate system” uses fiducial markers as a reference to describe with high accuracy the position of specific structures within this arbitrarily defined space. The surgeon then refers to that data to target particular structures within the brain. This technology was boosted by the collection of data on human anatomy in “stereotactic atlases”, expanding the quantitatively defined “targets” that could be readily used in surgery. Finally, the advent of modern neuro-imaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI)—along with the ever-increasing capabilities of digitalization, computer-graphic modelling and accelerated manipulation of data through complex mathematical algorithms via robust computer technologies—made possible the real-time quantitative spatial fusion of images of the patient's brain with the created “fiducial coordinate system” for the purpose of guiding the surgeon's instrument or probe to a selected target. In this way the observations done via highly sophisticated neuro-imaging technologies (CT, MRI, angiography) are related to the actual patient during surgery.
The ability to relate the position of a real surgical instrument in the surgeon's hand or the microscope's focal point to the location of the imaged pathology, updated in "real time" in an "integrated operating room", highlights the modern version of this set of technologies. In its current form, neuronavigation began in the 1990s and has adapted to new neuro-imaging technologies, real-time imaging capabilities, new technologies to transfer the information in the operating room for 3-D localization, real-time neuro-monitoring, robotics, and new and better algorithms to handle data via more sophisticated computer technology.
In its later conceptualization, the term neuronavigation has started to overlap fuse with surgical-virtualization in which a neurosurgeon is able to visualize the scenario for surgery in a 3-D model of manipulable computer data. In this way the physician can "practice and check" the surgery, try alternative approaches, assess possible difficulties, etc., before the real surgery takes place.
The standard TMS protocol which was FDA approved in 2008 estimates the location of the DLPFC by finding the left motor cortex and marking a spot 5 cm anterior to it. Later two more methods were introduced using measurements of the head and calculating the location of the DLPFC as 1) the F3 (EEG 10/20 system) or 2) the Beam method. Both were estimations with some limitations. With the introduction of Neuronavigation, direct visualization of structures can be achieved either with an individual's (specially ordered) MRI or an average brain (MNI) stretched to the dimensions of the individual. There is now greater significance of this increased accuracy due to recent evidence that stimulation of the gyral crown is less effective than stimulation of the sulcal bank. The introduction of robotic controlled TMS also may make Neuronavigation more important. Several manufacturers offer complete systems including Ant Neuro or Axilum Robotics.
Assistive technologies are used during spinal fusion surgery to increase accuracy, especially for the placement of pedicle screws. [1] A review of navigation techniques for spine surgery published in 2019 listed four currently available options: [2]
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peripheral nervous system.
Transcranial magnetic stimulation (TMS) is a noninvasive form of brain stimulation in which a changing magnetic field is used to induce an electric current at a specific area of the brain through electromagnetic induction. An electric pulse generator, or stimulator, is connected to a magnetic coil connected to the scalp. The stimulator generates a changing electric current within the coil which creates a varying magnetic field, inducing a current within a region in the brain itself.
Neurotechnology encompasses any method or electronic device which interfaces with the nervous system to monitor or modulate neural activity.
Myelopathy describes any neurologic deficit related to the spinal cord. The most common form of myelopathy in humans, cervical spondylotic myelopathy (CSM), also called degenerative cervical myelopathy, results from narrowing of the spinal canal ultimately causing compression of the spinal cord. When due to trauma, myelopathy is known as (acute) spinal cord injury. When inflammatory, it is known as myelitis. Disease that is vascular in nature is known as vascular myelopathy.
Radiosurgery is surgery using radiation, that is, the destruction of precisely selected areas of tissue using ionizing radiation rather than excision with a blade. Like other forms of radiation therapy, it is usually used to treat cancer. Radiosurgery was originally defined by the Swedish neurosurgeon Lars Leksell as "a single high dose fraction of radiation, stereotactically directed to an intracranial region of interest".
Stereotactic surgery is a minimally invasive form of surgical intervention that makes use of a three-dimensional coordinate system to locate small targets inside the body and to perform on them some action such as ablation, biopsy, lesion, injection, stimulation, implantation, radiosurgery (SRS), etc.
Image-guided surgery (IGS) is any surgical procedure where the surgeon uses tracked surgical instruments in conjunction with preoperative or intraoperative images in order to directly or indirectly guide the procedure. Image guided surgery systems use cameras, ultrasonic, electromagnetic or a combination of 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 or to augmented reality headsets. This is generally performed in real-time though there may be delays of seconds or minutes depending on the modality and application.
Neuroimaging is the use of quantitative (computational) techniques to study the structure and function of the central nervous system, developed as an objective way of scientifically studying the healthy human brain in a non-invasive manner. Increasingly it is also being used for quantitative research studies of brain disease and psychiatric illness. Neuroimaging is highly multidisciplinary involving neuroscience, computer science, psychology and statistics, and is not a medical specialty. Neuroimaging is sometimes confused with neuroradiology.
Neuroergonomics is the application of neuroscience to ergonomics. Traditional ergonomic studies rely predominantly on psychological explanations to address human factors issues such as: work performance, operational safety, and workplace-related risks. Neuroergonomics, in contrast, addresses the biological substrates of ergonomic concerns, with an emphasis on the role of the human nervous system.
Talairach coordinates, also known as Talairach space, is a 3-dimensional coordinate system of the human brain, which is used to map the location of brain structures independent from individual differences in the size and overall shape of the brain. It is still common to use Talairach coordinates in functional brain imaging studies and to target transcranial stimulation of brain regions. However, alternative methods such as the MNI Coordinate System have largely replaced Talairach for stereotaxy and other procedures.
A fiducial marker or fiducial is an object placed in the field of view of an imaging system that appears in the image produced, for use as a point of reference or a measure. It may be either something placed into or on the imaging subject, or a mark or set of marks in the reticle of an optical instrument.
NeuroArm is an engineering research surgical robot specifically designed for neurosurgery. It is the first image-guided, MR-compatible surgical robot that has the capability to perform both microsurgery and stereotaxy.
Patient registration is used to correlate the reference position of a virtual 3D dataset gathered by computer medical imaging with the reference position of the patient. This procedure is crucial in computer assisted surgery, in order to insure the reproducitibility of the preoperative registration and the clinical situation during surgery. The use of the term "patient registration" out of this context can lead to a confusion with the procedure of registering a patient into the files of a medical institution.
Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assisted intervention, image-guided surgery, digital surgery and surgical navigation, but these are terms that are more or less synonymous with CAS. CAS has been a leading factor in the development of robotic surgery.
Connectomics is the production and study of connectomes: comprehensive maps of connections within an organism's nervous system. More generally, it can be thought of as the study of neuronal wiring diagrams with a focus on how structural connectivity, individual synapses, cellular morphology, and cellular ultrastructure contribute to the make up of a network. The nervous system is a network made of billions of connections and these connections are responsible for our thoughts, emotions, actions, memories, function and dysfunction. Therefore, the study of connectomics aims to advance our understanding of mental health and cognition by understanding how cells in the nervous system are connected and communicate. Because these structures are extremely complex, methods within this field use a high-throughput application of functional and structural neural imaging, most commonly magnetic resonance imaging (MRI), electron microscopy, and histological techniques in order to increase the speed, efficiency, and resolution of these nervous system maps. To date, tens of large scale datasets have been collected spanning the nervous system including the various areas of cortex, cerebellum, the retina, the peripheral nervous system and neuromuscular junctions.
Cortical stimulation mapping (CSM) is a type of electrocorticography that involves a physically invasive procedure and aims to localize the function of specific brain regions through direct electrical stimulation of the cerebral cortex. It remains one of the earliest methods of analyzing the brain and has allowed researchers to study the relationship between cortical structure and systemic function. Cortical stimulation mapping is used for a number of clinical and therapeutic applications, and remains the preferred method for the pre-surgical mapping of the motor cortex and language areas to prevent unnecessary functional damage. There are also some clinical applications for cortical stimulation mapping, such as the treatment of epilepsy.
The SurgiScope is a microscope and robot designed to hold tools and assist in positioning those tools during neurosurgery. The unit is mounted on the ceiling and can hold instruments such as endoscopy tools, biopsy needles, and electrodes. The associated software allows for target and trajectory determination. The SurgiScope has been used for stereotactic guidance and neuronavigation during surgical procedures.
Brainlab is a privately held German medical technology company headquartered in Munich, Bavaria. Brainlab develops software and hardware for radiotherapy and radiosurgery, and the surgical fields of neurosurgery, ENT and craniomaxillofacial, spine surgery, and traumatic interventions. Their products focus on image-guided surgery and radiosurgery, digital operating room integration technologies, and cloud-based data sharing.
Nazir Ahmad is a neurosurgeon from Pakistan.
Ferenc Andras Jolesz was a Hungarian-American physician and scientist best known for his research on image guided therapy, the process by which information derived from diagnostic imaging is used to improve the localization and targeting of diseased tissue to monitor and control treatment during surgical and interventional procedures. He pioneered the field of Magnetic Resonance Imaging-guided interventions and introduced of a variety of new medical procedures based on novel combinations of imaging and therapy delivery.