Lucia J. Zamorano

Computer-Assisted Neurosurgery: Simulation and Automation

Instrumentation has been developed to automate, accurately guide, and integrate microsurgery laser resection equipment that is used in stereotactic brain surgery. The instrument is a computer-controlled laser-guiding system. The improvement in the accuracy comes from relying on a certain well-referenced three-dimensional surgical orientation, and computer-preplanned tumor contours, rather than only the surgeons hand-eye orientation in the operating room.

Tumour Recurrence vs Radionecrosis: an Indication for Multitrajectory Serial Stereotactic Biopsies

External RT has been proved to be an important adjuvant to surgery in the treatment of malignant glioma. It has also been demonstrated, that its effect on survival is dose-dependent, although accompanied by a higher morbidity. Intents to localize the field of high dose RT to the tumour area have been performed with the aim to spare damage of the normal brain tissue. Between August 1983 to December 1987, 40 patients with malignant astrocytoma (16 GM, 24 AA) underwent high dose localized hyperfractionated external RT after surgical resection. Patients received 57.6 Gy to the tumour and oedema area associated with a boost localized to the tumour of 7.4, 14.4 or 24 Gy. In the follow-up, 16 patients died with evidence of increase in size of lesion diagnosed by CT/MRI. Since July 1987, 12 patients with recurrence or increase on size of CT/MRI lesion have undergone multitrajectory serial stereotactic biopsies. From the biopsies 8 patients were histologically diagnosed was compatible with radionecrosis. From the 4 recurrences, 2 patients were treated with 125I implants and 1 with new resection. Patients with radionecrosis were treated with corticoides and diuretics, obtaining partial or complete remission of symptoms and decrease in size of CT lesion. Undoubtly, Multiplanar/3D multitrajectory serial stereotactic biopsies play a major role in the follow-up of these patients, and accurate diagnosis need to be established for further treatment therapy. The question remains if these localized boost should be replaced by 3D Multiplanar stereotactic interstitial radiotherapy boost after surgery and conventional radiotherapy.

Application of Multimodality Imaging Stereotactic Localization in the Surgical Management of Vascular Lesions

Multidimensional image preplanning and accurate pre and intraoperative localization for intracranial vascular lesions have been implemented. Methodology include carbon fiber base ring, localizer plates, any X-ray tubes, PC compatible software and intraoperative localizing unit. Surgical management of deep arteriovenous malformations is especially suitable for this technique, including the use of intraoperative digital angiography.

Influence of helium, oxygen, nitrogen, and room air environment in determining Nd-YAG laser/brain tissue interaction

The present study attempts to assess the in-vivo effects of Nd:YAG laser irradiation on the brain in different gaseous environments. Such an investigation is critical for determining the extent of injury under such conditions to further improve clinical applications. The authors define the influence on laser-tissue interaction of room air, 30% oxygen, helium, and nitrogen