A. Majeed Kadi

Interactive intraoperative localization using an infrared-based system.

We discuss new methods of localizing and treating brain lesions for both the conventional method of a base-ring fixed to the patients skull (referred to as frame-based procedures) and the new method of frameless procedures (no base ring). Frame-based procedures are used for finding a precise instrument position during neurosurgical procedures, such as stereotactic biopsy of deep-seated lesions, placing electrodes for functional stereotaxis or catheters with radioactive seeds for brachytherapy, or even the placement of a stereotactic retractor or endoscope for removal or internal decompression of lesions. In such procedures, the intraoperative image localization of instruments becomes useful as it tracks instruments as they travel through the preplanned trajectory. Additional intraoperative digitization of surgical instruments, e.g., bipolar suction, biopsy forceps, microscope, ultrasound probe, etc, can be achieved during the stereotactic resection of eloquent areas or deep intracranial lesions by adding an infrared-based system. Frameless procedures broaden the range of surgical approaches, image guidance planning, and operative procedures, since no ring is attached to the patients head which might interfere with the surgical approach, and offers logistic advantages in scheduling diagnostic studies. Frameless diagnostic studies employ anatomical markers and/or surface matching techniques for data registration in the computer software surgical preplanning program. This simplifies scheduling of the procedures since the image study does not need to be acquired the same day as surgery. Frameless diagnostic studies allow for the use of more than one type of imaging data for planning and optimization of surgical procedures, and greatly improve patient tolerance and comfort during these procedures and during surgery, as compared with frame-based procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer-assisted neurosurgery system: Wayne state university hardware and software configuration

Computer-assisted neurosurgery uses the latest technological advancements in imaging, computers, mechanics, and electronics to improve the accuracy and reduce the invasiveness and risk of neurosurgical procedures. We describe the Wayne State University, Detroit, Michigan, computer-assisted neurosurgical system with the emphasis on software and discuss the theory guiding the development of this system and its application in real-time position tracking systems. Our system consists of the Neurological Surgery Planning System (NSPS) software which we developed at our medical center and three types of position tracking systems: the Zamorano-Dujovny (Z-D) are digitizer for frame-based procedures, an articulated arm, and an infrared-based digitizer for frameless procedures. The NSPS software is designed to offer neurosurgeons a safe and accurate method to approach intracranial lesions by preoperatively planning a surgical trajectory. Software consisting of the most advanced technologies in computer vision, computer imaging/graphics, and stereotactic numeric analysis forms the core of the system. Capabilities for correlating data from imaging studies to facilitate image reconstruction, image mapping, and three-dimensional (3D) visualization of target volumes enable the neurosurgeon to simulate surgical procedures into a preoperative protocol to be used during surgery, both to follow the preplanned trajectory and to track the position of surgical instruments in real-time on the computer monitor. The tracking systems position and orient the surgical instruments relative to the patients head. With these devices, the display of the surgical instruments together with the virtual images create an excellent intraoperative tool.

Design and simulation of an articulated surgical arm for guiding stereotactic neurosurgery

In stereotactic surgery, the need exists for means of relating intraoperatively the position and orientation of the surgical instrument used by the neurosurgeon to a known frame of reference. An articulated arm is proposed which would provide the neurosurgeon with on-line information for position, and orientation of the surgical tools being moved by the neurosurgeon. The articulated arm has six degrees of freedom, with five revolute and one prismatic joints. The design features include no obstruction to the field of view, lightweight, good balance against gravity, an accuracy of 1 mm spherical error probability (SEP), and a solvable kinematic structure making it capable of fitting the operating room environment. The arm can be mounted on either the surgical table or the stereotactic frame. A graphical simulation of the arm was created using the IGRIP simulation package created by Deneb Robotics. The simulation demonstrates the use of the arm, mounted on several positions of the ring reaching various target points within the cranium.

Neurological surgery planning system

The computer-assisted neurological surgery planning system (NSPS), developed by the Neurological Surgery Department, Wayne State University, Detroit, MI, is designed to offer neurosurgeons a safe and accurate method to approach intracranial lesions. Software consisting of the most advanced technologies in computer vision, computer graphics, and stereotactic numeric analysis forms the kernel of the system. Our paper discusses the functionalities and background theories used in NSPS.

Stereotactic brain surgery: instrumentation, automation, and image guidance

In the 1960s stereotactic surgery was done merely by taking two projective images, using hand calculations to determine the numerical values, and deriving a set of specific measurements that guided a needle through an eloquent part of the brain. This type of surgery developed through the years, taking advantage of the new technologies in imaging modalities, networking, advanced video systems, high speed computer workstations, to the most sophisticated technology currently available, digitizing systems using infrared sensing technology.

Intraoperative real-time localization of brain tumors

In stereotactic neurosurgery several localizing systems such as robotic or articulated arms and sonic digitizers can correlate on-site surgical points with precaptured multi-modality images. We discuss a strategy for intraoperative real-time localization of brain tumors using an opto- electronic system with light emitting diodes (LED).

Infrared system for intraoperative digitization of laser and surgical instruments

In neurosurgery localization is the process of matching the imaging data generated by an imaging modality such as computed tomography or magnetic resonance imaging with the patients brain during surgery. This process is done intraoperatively using several methods. Using infrared signals is one of these methods. In this paper we describe a system that uses infrared as a tool to determine a position in three-dimensional space. We also describe a computer-based neurological image data acquisition and correlation system that assists the neurosurgeon with preplanning, simulation, and optimization of the ~mrgical procedures and shows the safest approach to J.esions. We describe localization in laser resection procedures for bot.h contact (NdYAG) and non-contact (C02 ) lasers.

Computer-assisted laser volumetric resection of intracranial lesions

Computer-assisted stereotactic neurological surgery, together with laser instruments, can help neurosurgeons locate and resect deep brain tumor more accurately and more conveniently than traditional techniques. Several successful neurosurgical computer imaging systems already exist, such as Compass and the Neurosurgical Planning System (NSPS-3.0). These systems offer successful software and hardware tools for surgery planning as well as real-time laser instrument guidance.

Computer-assisted resection of brain lesions

To meet the high accuracy demands of most brain lesion resection surgeries, surgeons are always looking out for new and more reliable guiding systems and methods. In this paper we are presenting a system that has been developed through many years of experience in brain surgery and hundreds of stereotactic brain lesion resection operations. The computer assisted system consists of a special designed software and hardware. The software starts by collect the data directly from different types of imaging systems, then using several modules of interactive 2D-3D graphic displays enables the surgeon to simulate, optimize, and plan the surgery. The hardware consists two main parts. The first part is a localizing unit with a set of instrument, that provide the reference system needed for the imaging data preoperatively and intraoperatively. The second part is an intraoperative automated image guided system for microscopic based resection cases.