Neurosurgery
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Case Reports Comparative Study
Fiber tractography based on diffusion tensor imaging compared with high-angular-resolution diffusion imaging with compressed sensing: initial experience.
The most frequently used method for fiber tractography based on diffusion tensor imaging (DTI) is associated with restrictions in the resolution of crossing or kissing fibers and in the vicinity of tumor or edema. Tractography based on high-angular-resolution diffusion imaging (HARDI) is capable of overcoming this restriction. With compressed sensing (CS) techniques, HARDI acquisitions with a smaller number of directional measurements can be used, thus enabling the use of HARDI-based fiber tractography in clinical practice. ⋯ HARDI+CS seems to be a promising approach for fiber tractography in clinical practice for neuroanatomically complex fiber pathways and in areas of disturbed diffusion, overcoming the problem of long acquisition times.
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Operating microscopes are essential for most neurosurgical procedures. Modern robot-assisted controls offer new possibilities, combining the advantages of conventional and automated systems. ⋯ The prototype of a robotized optical coherence tomography-integrated operating microscope combines the advantages of a conventional manually controlled operating microscope with a remote-controlled positioning aid and a self-navigating microscope system that performs automated positioning tasks such as surface scans. This demonstrates that, in the future, operating microscopes may be used to acquire intraoperative spatial data, volume changes, and structural data of brain or brain tumor tissue.
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Cranial surgical navigation is most commonly performed by registration with fiducial markers, optic tracking, and intermittent pointer-based application. ⋯ Continuous instrument navigation is the prerequisite for seamless integration of navigation systems into the neurosurgical operating workflow. Our data confirm that the application of preoperative imaging, surface-merge registration, and continuous electromagnetic tip-tracked instrument navigation may provide such integration without a significant reduction in accuracy compared with standard navigation.
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Idiopathic normal pressure hydrocephalus (iNPH) causes cognitive decline that can be alleviated by shunting, but long-term outcome studies are scarce. ⋯ The novel findings were (a) a significant risk of dementia in iNPH initially responsive to cerebrospinal fluid shunt, (b) cognitive impairment most commonly due to iNPH-related dementia followed by concurrent degenerative brain disease, and (c) a subgroup with dementia related to iNPH without comorbidities.
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Intraoperative imaging disrupts the rhythm of surgery despite providing an excellent opportunity for surgical monitoring and assessment. To allow surgery within real-time images, neuroArm, a teleoperated surgical robotic system, was conceptualized. The objective was to design and manufacture a magnetic resonance-compatible robot with a human-machine interface that could reproduce some of the sight, sound, and touch of surgery at a remote workstation. ⋯ During the preliminary design review, the scope of the neuroArm project changed to performing microsurgery outside the magnet and stereotaxy inside the bore. neuroArm was successfully manufactured and installed in an intraoperative magnetic resonance imaging operating room. neuroArm was clinically integrated into 35 cases in a graded fashion. As a result of this experience, neuroArm II is in development, and advances in technology will allow microsurgery within the bore of the magnet. neuroArm represents a successful interdisciplinary collaboration. It has positive implications for the future of robotic technology in neurosurgery in that the precision and accuracy of robots will continue to augment human capability.