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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Continuous precise motions are required in microneurosurgery to provide high-quality surgical results. Stabilizing the surgeon's arm and reducing fatigue during surgery are expected to improve the precision of microsurgical procedures. We have developed an intelligent armrest, EXPERT, that follows the surgeon's hand and fixes at an adequate position automatically using robotics technology. ⋯ EXPERT is a useful tool for holding the surgeon's arm comfortably and following the surgeon's arm automatically.
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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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Case Reports Clinical Trial
Mono-stereo-autostereo: the evolution of 3-dimensional neurosurgical planning.
In the past decade, surgery planning has changed significantly. The main reason is the improvements in computer graphical rendering power and display technology, which turned the plain graphics of the mid-1990s into interactive stereoscopic objects. ⋯ Improvement of display and interaction techniques adds to the realism of the planning process and enables precise structural understanding preoperatively. This minimizes intraoperative guesswork and exploratory dissection. Autostereoscopic display techniques will further increase the value and acceptance of 3-dimensional planning and intraoperative 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.