Neurosurgery
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Neurosurgeons are faced with the challenge of learning, planning, and performing increasingly complex surgical procedures in which there is little room for error. With improvements in computational power and advances in visual and haptic display technologies, virtual surgical environments can now offer potential benefits for surgical training, planning, and rehearsal in a safe, simulated setting. This article introduces the various classes of surgical simulators and their respective purposes through a brief survey of representative simulation systems in the context of neurosurgery. ⋯ Although we cannot yet expect a digital patient to be indistinguishable from reality, new developments in computational methods and related technology bring us closer every day. We recognize that the design and implementation of an immersive virtual reality surgical simulator require expert knowledge from many disciplines. This article highlights a selection of recent developments in research areas related to virtual reality simulation, including anatomic modeling, computer graphics and visualization, haptics, and physics simulation, and discusses their implication for the simulation of neurosurgery.
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The cause of rupture of intracranial aneurysms (IA) is not well understood. We previously demonstrated that loss of cells from the IA wall is associated with wall degeneration and rupture. ⋯ Our results show that programmed cell death is activated in the IA wall via the intrinsic pathway. High oxidative stress in the IA wall is probably a significant cause of the intrinsic activation of cell death.
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Robots are becoming increasingly relevant to neurosurgeons, extending a neurosurgeon's physical capabilities, improving navigation within the surgical landscape when combined with advanced imaging, and propelling the movement toward minimally invasive surgery. Most surgical robots, however, isolate surgeons from the full range of human senses during a procedure. This forces surgeons to rely on vision alone for guidance through the surgical corridor, which limits the capabilities of the system, requires significant operator training, and increases the surgeon's workload. ⋯ Thus, this article serves as an introduction to the field of haptics for neurosurgeons. We not only outline the current and future benefits of haptics but also introduce concepts in the fields of robotic technology and computer control. This knowledge will allow readers to be better aware of limitations in the technology that can affect performance and surgical outcomes, and "knowing the right questions to ask" will be invaluable for surgeons who have purchasing power within their departments.
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Case Reports Clinical Trial
Image-guided neurosurgery with 3-dimensional multimodal imaging data on a stereoscopic monitor.
In the past 2 decades, intraoperative navigation technology has changed preoperative and intraoperative strategies and methodology tremendously. ⋯ We consider navigating primarily with stereoscopic, 3-D multimodality data an improvement over navigating with image planes, and we believe that this technology enables a more intuitive intraoperative interpretation of the displayed navigational information and hence an easier surgical implementation of the preoperative plan.
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Retrograde leptomeningeal venous drainage (RLVD) in dural arteriovenous fistulas (DAVFs) is associated with intracerebral hemorrhage and nonhemorrhagic neurological deficits or death. Angiographic evidence of RLVD is a definite indication for treatment, but less invasive methods of identifying RLVD are required. ⋯ The presence of SWI hyperintensity within the venous structure could be a useful indicator of RLVD in DAVF patients. Thus, SWI offers a noninvasive alternative to angiography for the identification of RLVD in pretreated and posttreated DAVF patients.