Madoka Sugiura

New possibilities for stereotaxis. Information-guided stereotaxis.

Information-guided stereotaxis, assisted by visualization of medical information, will become the next generation of neurosurgical systems. We performed 76 open MRI surgeries at Tokyo Women’s Medical University between March 3, 2000 and April 12, 2001. Of them, comparisons of pre- and post-operative MR images for malignant gliomas in 21 cases revealed an average resection rate of 90.3% (the maximum 100%, the minimum 55%). In this article we describe real time updated navigation, augmented reality navigation, three-dimensional navigation, chemical navigation, information-guided navigation system (High definition visual Computer Aided Surgery System: HivisCAS), and open MRI-guided surgery that we are developing.

Photon radiosurgical system for treating brain tumors

A small, handy portable X-ray generator, photon radiosurgical system (PRS) was evaluated its efficacy to treat malignant brain tumors. Most of the tumors were treated by intraoperative radiation with PRS to the residual tumors. Some tumors were treated by stereotactically applied PRS after the biopsy of the tumor without craniotomy. The accurate position of the tip of the PRS probe into the brain tumor was decided by using the operative navigator with an open MRI in the operating theater. Seventyeight cases of malignant brain tumors were treated from 1995 to 1999. All cases were completely followed up for more them 2 years after the treatment. The radiation by PRS decreased the size of the tumor very quickly. The post surgical 2 years survival rate of primary glioblastoma was 40 percent and it of anaplastic astrorytoma was 90 percent. The data were the best survival rates ever reported for those malignant gliomas. PRS can give locally focussed strong radiation effect with quite localized hyperthermia at the site of the tip of the PRS probe. PRS can be used safely without any serious complications and it is anticipated to be used also for treating various malignant tumors other them brain tumors.

Development of Hitchcock stereotactic frame for intraoperative open MRI

We have introduced open MRI into the operating room. When taking intraoperative open MR (iMR) images conventionally, since it was impossible to have used a conventional head coil for diagnosis because of need of space, we used to wrap the body coil around the patient’ head to get signal. However, the body coil was less sensitive, wrapping the coil was very rough. Then we have developed Hitchcock Coil for intraoperative open MRI (iMRI). Hitchcock Coil works not only as more sensitive receiving coil than conventional one, but also as iMRI-guided Hitchcock stereotactic device (Hitchcock device), that is to say Navigation System using markers for iMRI. This time we confirmed that Hitchcock Coil were more excellent than the conventional receiving coil in respect of contrast and space resolution, and were acceptable to iMRI.

Open MRI compatible HivisCAS video microscope system for neurosurgery

We are developing a video microscope system “HivisCAS (High Definition Visual Computer Aided Surgery system)”, which guides the surgeon by enhancing the live microscope image with superimposed computer graphics of the surgical plan map in 0.5 mm accuracy[1]. On the other hand, we have introduced an intraoperative MRI (AIRIS II 0.3T; Hitachi, Tokyo). To update the surgical plan map by intraoperative images, we modified the video microscope to be compatible with the open MRI, and evaluated its problems and performance.