Der Nervenarzt
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With the recent developments in computer technology and the improvements in modern neuroimaging, frame-based stereotactic guidance for open microsurgical procedures has been increasingly replaced by neuronavigation, also called frameless stereotaxy. It allows transfer of individual patientís images onto the operative field to assist the neurosurgeon intraoperatively in defining the tumor margins or identifying functionally important brain areas. The different localization techniques employed are articulated position-sensing arms, infrared or ultrasound systems working with the principle of satellite navigation and robotic systems integrated with the operating microscope. ⋯ Intraoperative magnetic resonance imaging (MRI) might be a solution for this problem. With the method of intraoperative MRI developed in our department it has already been possible to update neuronavigation with images reflecting intraoperative changes in anatomy. Therefore, neuronavigation is definitely a method with growing importance in operative routine, and it will also spread into other surgical specialties.
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In 1994 this journal published the results of a survey undertaken on behalf of the Working Association for Neurological Intensive Care Medicine (ANIM) in the winter of 1992/93. In the winter of 1996/97 a continuation of this analysis was performed. With the help of a questionnaire the data of 62 intensive care units with a total of 420 beds were established. ⋯ The overall time of ventilation increased to 48 per cent. Overall there are, however, considerable differences between individual units as well as regions. The data presented can serve as a means to monitor the quality of neurological intensive care.