Neurosurgery and Stereotaxic Navigation

The possibility of unintentional contact with other organs during surgery necessitates the use of Stereotaxic Navigation. Increased healthcare, protection, and quality promotion of contemporary medical research has improved the outcome of even the most delicate surgical procedures. High-risk surgeries have become easier to perform thanks to technological innovation. Furthermore, improved methods and methodologies have integrated a variety of interest groups that all agree on the importance of protection and performance. Using robotics to navigate organs during surgery is a dependable capability that helps to secure such fragile tissues and organs as the spinal cord and brain, among others. The emerging focus on stereotaxic tracking system in neurosurgery is a welcome in this era of increased healthcare promotion on patient safety.

Patients are exposed to the risks of cutting and drilling of bones when accessing lesions and tumors. Here, accidental plunging of the surgical drill can occur to the brain and spinal cord. The patient can incur cranial nerves, blood vessels as well as brain tissues that are damaged. Brain exposure may also lead to infection that might cause the need for extra surgeries as well as further increases to healthcare costs. There are also risks of developing plunging complications of perforators and cranial drills [1]. Robotic surgery benefits the patient by providing advanced treatment of illnesses that are complicated. They provide healthcare using current technology that helps the patient to heal from illnesses that were earlier known to be terminal. The use of neurological tools assists in carrying out an operative procedure using technology [1]. This has improved the visualization system and minimal invasive trends in surgeries.

Neurosurgery means that there is significant danger exposed to the patient_x0092_s spinal cord, brain, and nerve roots. Surgical tools that can assist in improving the outcomes of the surgery are useful for achieving accuracies and shorter time in the surgical procedure as well as benefiting through lower costs. Robotic tracking as well as imaging technologies are useful in improving the outcomes of neurosurgical in the operating room [1]. This paper highlights the stereotaxic navigation in neurosurgery and the overall procedures that are involved in the process.

II. METHOD

Stereotaxic navigation works on different frame systems that are based on essential principles and regularities. It functions with the help of three main constituents which are a stereotaxic planning system, a stereotaxic apparatus or device, and a stereotaxic placement and localization process.

Stereotaxic navigation with framed or frameless systems provides important functions of neuro-navigation in cranial surgery [2]. The localization process can substantially limit the bone opening size or craniotomy ensuring a safe removal in intra-axial lesions such as ones developed in brain cancer (tumor resection). These systems can be helpful aides in multiple spinal surgeries as well for instance the insertion of pedicle screws in the vertebral column, particularly the thoracic spine. The technology can effectually be implemented at the C1-2 level and cranio-vertebral junction.

Modern and the most updated version of robotic navigation involve efficient planning systems as they are digitally modified and placed. The defined atlas is a group of different sections and divisions of organ structures and anatomies (for instance, brain of human), represented in association to a dual frame coordinate. Therefore, individual ideology in the brain can be feasibly provide an extensive series of three synchronized codes, which will be implemented for the stereotaxic equipment placement. In most cases, the three dimensions are: dorso-ventral (y), latero-lateral (x), and rostro-caudal (z). The stereotaxic equipment uses a group of three synchronized codes (x, y and z) in a reference frame that is orthogonal in nature, or otherwise, a suitable coordinate arrangement, having three coordinates: depth, angle, and antero-posterior location [3]. The y, x and z are axial cross sections viewed in the imaging of the patient_x0092_s head. Z is derived from calculating the distance between the oblique rod and horizontal rod of the image cross-section. The x and y coordinates of the image target are obtained using a similar method [4]. The navigation device controls clamps that hold the head in position and bars which provide a fixed position for head in positioning to origination and coordination mechanisms.

Calibration methods entail using formulas to calculate the angle values of the coordinate system. Forward and inverse kinematic analyses are methods used in computing the angle values when the prismatic joints and position as well as needle orientation are given respectively. In mapping the CT/MR coordinate system to the frame coordinate, these formulas will compute the needle tip position [4].

III. DISCUSSION

Stereotaxic navigation has multiple advantages and accuracy considerations as it provides and effective, safe, and minimally invasive alternatives for different treatments. The technique can be utilized for patients diagnosed with benign, malignant, and functional indications in the central and peripheral nervous systems, involving but not restricted to both primary and secondary tumors. Stereotaxic navigation provides optimum frameless equipment as well with the help of recent advancements in optical and computer hardware as well increasing the surgeon_x0092_s freedom and flexibility during surgical procedures. The improvisation in image-guided surgery have been applied for intraoperative navigational support for management of various neurosurgical approaches (such as craniofacial and otolaryngology issues). From the innovation of stereotaxic frame, different systems have been formed that record patients_x0092_ images to the frame of reference, then track the post-registration condition [5]. These systems involve vision-based optical tracking equipment, stereotaxic articulated arms, magnetic systems, and acoustical systems.

The most important disadvantage of this system is the mechanical association which can be unwieldy and has restricted freedom gradations. While the infrared LED technical prospects provide good accuracy and have ease of movement in the surgical field, there are some minute details that are to be noted. The line of sight between the probe, the charged coupled device cameras, and the microscope should remain unhindered [6]. However, it has been observed that metallic objects in the surgical field can cause disturbance in the magnetic reception.

Stereotaxic navigation is a method of navigation method in neurosurgery and permits the reaching of targets within the brain using high precision. It is a tiny robotic machine with five joints that is usually attached to the patient_x0092_s head during brain surgery. It is an instrument in the form of a needle that is movable by way of changing the joint angles settings. The joints are indicated with letters and are regarded as revolute joints. A stereotaxic frame is used in holding the patient_x0092_s head in place during the surgery process. The frame consists of three parts including the frame base, localizer frame, and the passive jointed mechanism. The frame base forms a direct attachment to the head. The localizer frame is in the form of a box with localizers for CT and MR imaging and it attaches to the base. These localizers are called fiducials. The passive jointed mechanism is rigidly attached to the base of the frame [4].

The accuracy of stereotaxic navigation is dependent on different factors affecting the intraoperative accuracy of stereotaxic systems. Target localization greatly depends on the localizer technology present in 3D space. The software and computer applications maintain the correspondence and response generation between the localizer information and the images. Accuracy is also ensured with the target stability and the capability of the localizer to attempt on the target in physical space [5]. Having an infrared pointer system that is LED-based, the localization process for the targets has increased.

Research projects at present are focusing on the significance of three major areas for improvement considering neurosurgical robots. One of them is to increase the overall efficacy and/or accuracy of the conventional stereotaxic navigation and surgical systems; another is to increase the value and importance of the equipment and the last is to further improve the capabilities of human surgeons in the operation theatre [7]. There is a considerable amount of research ongoing to represent how these trends are being vitally identified with scientific development and resourceful techniques. The benefits and added compensations are also being outlined for future patients [8]. Security and patient safety is of utmost value, and may always determine how research is conducted.

IV. CONCLUSION

Critical review of this topic explores the underlying medical technology milestones so far achieved. Although the surgical field applies Stereotaxic Navigation of Neurosurgery, a lot of consideration must be given to the subtle elements of spinal and cerebrum surgeries to coordinate more up to date and better components of surgical life systems. There are reliable indications that stereotaxic route can be adjusted all the more attainably into the neurosurgeons with exceptional capability working condition. For the arrangement of future finesse, computerization, improvement of capacity and tangible criticism, it is of fundamental incentive that surgical robots are increasingly used with significant attention, accuracy and consistency to boost efficiency and save lives. Robots that have been utilized generally in neurosurgery are clarified in the professional setting. Focusing on central nervous system and other delicate organs is a noble course. In fact, the discourse gives suggestions and change possibilities that fit into the future. Medical endeavors to adjust extra instrumentation for neurosurgical applications have likewise been expounded in a cautious way to ensure sustainable, ethical and safety surgery processes.

REFERENCES

[1] J. Smith, J. Andrew., W. Jamil and Y. Ronnie, “30 Years of Neurosurgical Robots: Review and Trends for Manipulators and Associated Navigational Systems.” Annals of Biomedical Engineering, Vol. 44.no.4 (2016): 836-46. Web.

[2] M. Bunte, “Robotic arm aids in spinal surgery precision, speeds recovery - Mazor Robotics | Renaissance® Guidance System”, Mazor Robotics | Renaissance® Guidance System, 2016. [Online]. Available: http://www.mazorrobotics.com/robotic-arm-aids-in-spinal-surgery-precision-speeds-recovery/. [Accessed: 13- Dec- 2016].

[3] G. W. W., B. Chop and L. A, “An Assistive Image-Guided Surgical Robot System Using O-Arm Fluoroscopy for Pedicle Screw Insertion: Preliminary and Cadaveric Study: Errata”, Neurosurgery, vol. 68, no. 2, p. Bottom of TOC, 2011.

[4] A. Schweikard, and F. Ernst, _x0093_Medical Robotics,_x0094_ Springer.

[5] G. Ballantyne and F. Moll, “The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery”, Surgical Clinics of North America, vol. 83, no. 6, pp. 1293-1304, 2003.

[6] A. Darzi and Y. Munz, “The Impact of Minimally Invasive Surgical Techniques”, Annual Review of Medicine, vol. 55, no. 1, pp. 223-237, 2004.

[7] G. Watanabe, “Are you ready to take off as a robo-surgeon?”, Surgery Today, vol. 40, no. 6, pp. 491-493, 2010.

[8] W. Chitwood, L. Nifong, W. Chapman, J. Felger, B. Bailey, T. Ballint, K. Mendleson, V. Kim, J. Young and R. Albrecht, “Robotic Surgical Training in an Academic Institution”, Annals of Surgery, vol. 234, no. 4, pp. 475-486, 2001.