gms | German Medical Science

Objective: The concept of the computer-assisted neurosurgery is based on the assumption, that use of computer systems for planning and realization of the neurosurgical procedures can provide high degree of preciseness and accuracy, which could not be attained by ordinary microsurgical techniques. The various methods, such as real-time intraoperative navigation and robotic neurosurgery, are based on the new clinically-oriented computer programs. Intraoperative open MRI system (AIRIS II, Hitachi Medical, Tokyo, Japan) was installed in Tokyo Women`s Medical University in 2000, and 358 neurosurgical procedures were performed with this system. Low magnetic field energy (0.3 Tesla) creates narrow 5-gauss line, which permits use of ordinary, not MRI-compatible surgical instruments and devices. The patient can be easily moved in and out of the imager in the operating theater. Using of newly developed coil for scanning of open brain surgery provides significant improvement of image quality, and permits to obtain intraoperative diffusion-weighted images for visualization of the pyramidal tracts, functional MR images for identification of the motor cortex, and MRA for visualisation of the cerebral vessels. Intraoperative MRI combined with surgical navigation system (PRS navigator, Toshiba, Tokyo, Japan) permits easy identification of the residual tumor, which provides optimal conditions for better removal of gliomas, with a mean resection rate of 95%, even in the eloquent brain areas. The average mislocalization error of this device is just 0.8 mm. Creation of augmented reality system permits for the surgeon to refer to navigation information without moving the eyes outside of the surgical field. Development of robotic surgery system based on the combination of a microlaser ablaser and micromanipulator can provide further improvement of preciseness of the manipulations. Robotic neurosurgery is currently applied also to radiosurgical procedures. Autopositioning system combined with Gamma Knife model C, which we use from 2002, provides 0.1 mm accuracy, which permits to perform treatment for tumors very close to the radiation-sensitive structures, such as optic apparatus. Such precise procedures necessitate development of new MR images of improved quality and resolution, without distortion artifacts. Using of computer programs (Gamma Plan, Surgi Plan) permits to perform 3-dimensional reconstruction of the MR images, which is useful for prediction of the intraoperative situation and creation of the optimal surgical strategy in advance. Fusion of anatomical and metabolic neuroimages permits to obtain detailed information considering biology of the brain lesions. In conclusion, the recent computer-assisted neurosurgery provides optimal conditions for management of lesions located even in the eloquent brain areas and seems to be beneficial for patients by the improvement of both efficacy and safety of treatment.