Articles: surgery.
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Clinical neurophysiology has always played an important interventional role throughout the perioperative stages in functional neurosurgery. On the one hand, some neurophysiologic procedures have become an integrated part of neurosurgery. On the other hand, in deep brain stimulation, although the surgical electrode implantation is an essential step, the therapeutic effects are actually produced by electrically modulating the physiologic activity of the brain. We review the topic of neurophysiologic intervention in the deep brain stimulation for movement disorders by presenting the evidence derived from our own experiences based on an integrated group located at two hospitals in London and Oxford, UK, and mainly covering tremor caused by multiple sclerosis, Parkinson's disease and dystonia.
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The combination of classic neuronavigation and intraoperative ultrasound is a recent innovation in image guidance technology. However, this technique requires two hardware components (neuronavigation and an ultrasound system). It was the aim of the study to describe a new simplified technology of a so-called one-platform navigation system developed by our institution in collaboration with the industry and to demonstrate its range of various applications. ⋯ The integration of an ultrasound device into an existing navigation system has been successfully developed. The system offers a friendly user interface and cost-effective intraoperative imaging feedback. Although brain shift can be visualized by an image overlay technology as demonstrated by the present system, future developments should aim at fusion techniques of both intra- and preoperative image data sets.
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Catheter Cardiovasc Interv · Apr 2006
Real-time MRI guided atrial septal puncture and balloon septostomy in swine.
Cardiac perforation during atrial septal puncture (ASP) might be avoided by improved image guidance. X-ray fluoroscopy (XRF), which guides ASP, visualizes tissue poorly and does not convey depth information. Ultrasound is limited by device shadows and constrained imaging windows. ⋯ Septostomy achieved a mean left to right shunt ratio of 1.3:1 in these healthy animals. Interactive rtMRI permits rapid transcatheter ASP and BAS in swine. Further technical development may enable novel applications.
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Navigation systems are now frequently being used for guiding surgical procedures. Existing neuronavigation systems suffer from the lack of updated images when tissue changes during surgery as well as from user-friendly displays of all essential images for accurate and safe surgery guidance. ⋯ We claim that new features, as demonstrated in the present paper, using intraoperative 3D ultrasound in combination with advanced registration and display algorithms will represent important contributions towards more accurate, safer and more optimized future patient treatment.
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J. Thromb. Haemost. · Mar 2006
Letter Randomized Controlled Trial Comparative Study Clinical TrialOral surgery in patients on oral anticoagulant therapy: a randomized comparison of different INR targets.