Surgical planning is the preoperative method of pre-visualising a surgical intervention, in order to predefine the surgical steps and furthermore the bone segment navigation in the context of computer-assisted surgery. [1] The surgical planning is most important in neurosurgery and oral and maxillofacial surgery. The transfer of the surgical planning to the patient is generally made using a medical navigation system.
The imagistic dataset used for surgical planning is mainly based on a CT or MRI. In oral and maxillofacial surgery, a different, more "traditional" surgical planning can be used for orthognatic surgery, based on cast models fixed into an articulator.[ citation needed ]
In order to make a surgical planning, one would need a 3D image of the patient. The starting point was made by G. Hounsfield in the 1970s, by using CT in order to record data about the anatomical situation of the patients. [2] In the 1980s, advances were made by the radiologist M. Vannier and his team, by creating the first computed three-dimensional reconstruction from a CT dataset. [3] In the early 1990s, the surgical planning was performed by using stereolithographic models. [4] During the late 1990s, the first full computer-based virtual surgical planning was made for osteotomies, and then transferred to the operating theatre by a navigation system. [5] Currently 3D Printed models are also used to plan a procedure and improve patient outcomes. [6]
The first commercially available neurosurgical planning systems appeared in the 1990s (the StealthStation by Medtronic, [7] the VectorVision by Brainlab [8] ). As newer imaging modalities emerged providing increasing anatomical and functional detail for the patient in the 2000s, these surgical planning systems started to incorporate virtual reality technology to facilitate the visualisation and manipulation of the 3D data. One example of such systems is the Dextroscope, manufactured by Volume Interactions Pte Ltd. The Dextroscope is mostly used in the planning of complex neurosurgical procedures. [9] [10] [11] [12]
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.
An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It is also used to correct a coxa vara, genu valgum, and genu varum. The operation is done under a general anaesthetic.
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 or 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.
Orthognathic surgery, also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusion problems primarily arising from skeletal disharmonies, other orthodontic dental bite problems that cannot be easily treated with braces, as well as the broad range of facial imbalances, disharmonies, asymmetries and malproportions where correction can be considered to improve facial aesthetics and self esteem.
Electrocorticography (ECoG), or intracranial electroencephalography (iEEG), is a type of electrophysiological monitoring that uses electrodes placed directly on the exposed surface of the brain to record electrical activity from the cerebral cortex. In contrast, conventional electroencephalography (EEG) electrodes monitor this activity from outside the skull. ECoG may be performed either in the operating room during surgery or outside of surgery. Because a craniotomy is required to implant the electrode grid, ECoG is an invasive procedure.
Currarino syndrome is an inherited congenital disorder where either the sacrum is not formed properly, or there is a mass in the presacral space in front of the sacrum, and there are malformations of the anus or rectum. It occurs in approximately 1 in 100,000 people.
The surgical segment navigator (SSN) is a computer-based system for use in surgical navigation. It is integrated into a common platform, together with the surgical tool navigator (STN), the surgical microscope navigator (SMN) and the 6DOF manipulator (MKM), developed by Carl Zeiss.
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.
Bone segment navigation is a surgical method used to find the anatomical position of displaced bone fragments in fractures, or to position surgically created fragments in craniofacial surgery. Such fragments are later fixed in position by osteosynthesis. It has been developed for use in craniofacial and oral and maxillofacial surgery.
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.
Cone beam computed tomography is a medical imaging technique consisting of X-ray computed tomography where the X-rays are divergent, forming a cone.
Barrow Neurological Institute is the world's largest neurological disease treatment and research institution, and is consistently ranked as one of the best neurosurgical training centers in the United States. Founded in 1962, the main campus is located at 350 W. Thomas Road, Phoenix, Arizona.
A hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, X-ray computed tomography (CT) scanners or magnetic resonance imaging (MRI) scanners. These imaging devices enable minimally-invasive surgery. Minimally-invasive surgery is intended to be less traumatic for the patient and minimize incisions on the patient and perform surgery procedure through one or several small cuts.
James Ivan Ausman is an American neurosurgeon, science editor, television broadcaster, medical entrepreneur, and public advocate on health-care reform. He currently is professor of neurosurgery at the University of California, Los Angeles and editor-in-chief of Surgical Neurology International.
The Dextroscope is a medical equipment system that creates a virtual reality (VR) environment in which surgeons can plan neurosurgical and other surgical procedures.
Volume Interactions Pte Ltd was a company that pioneered in the 1990s the use Virtual Reality technology in surgery planning. The company created and marketed the Dextroscope, the first commercial surgical planning system that used virtual reality principles going beyond the mouse and keyboard. The Dextroscope introduced a variation of Virtual Reality technology that didn't use Head-Mounted display that provided a natural and comfortable interface to work with multi-modality 3D medical images for long periods of time. This environment was applied to the planning of patient-specific surgical approaches for several clinical disciplines, including neurosurgery, Ear-Nose-Throat, and liver surgery. The Dextroscope received world-wide attention by being involved in the planning of several craniopagus twin separations, most notably the Zambian twins (1997) and the German twins (2004) at Johns Hopkins Hospital led by Dr Benjamin Carson, and the Nepali twins separation at the Singapore General Hospital in 2001.
Yoko Kato is a Japanese neurosurgeon. She is professor and chair of the Department of Neurosurgery at Fujita Health University. She was the first woman in Japan to be promoted to full professor of neurosurgery.
Surgically assisted rapid palatal expansion (SARPE), also known as surgically assisted rapid maxillary expansion(SARME), is a technique in the field of orthodontics which is used to expand the maxillary arch. This technique is a combination of both Oral and Maxillofacial Surgery and Orthodontics. This procedure is primarily done in adult patients whose maxillary sutures are fused and cannot be expanded via other techniques.
The Dextrobeam is a highly interactive console that enables collaborative examination of three-dimensional (3-D) medical imaging data for planning, discussing, or teaching neurosurgical approaches and strategies. The console is designed to work in combination with a 3D stereoscopic display. The console enables two-handed interaction by means of two 6 Degree-of-Freedom motion tracking devices. A set of built-in software tools gives users the ability to manipulate and interact with patients’ imaging data in a natural and intuitive way.
Rolando Fausto Del Maestro is an Italian-born Canadian neurosurgeon, the William Feindel Professor Emeritus in neuro-oncology and director of the Neurosurgical Simulation Research Center at the Montreal Neurological Institute and Hospital, where he has been involved in mimicking real brain surgery by creating a virtual setting, founded upon the principles of flight simulation.
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