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Neuronavigation

FAQs about Neuronavigation:   

  1. What is neuronavigation?
  2. How does neuronavigation technology work?
  3. Why is it beneficial for surgeons to use neuronavigation during surgery?
  4. In what ways can the use of neuronavigation affect my recovery?
  5. What steps are involved in a procedure using neuronavigation?
  6. How do patients benefit from neuronavigation in brain surgery?
  7. How do patients benefit from neuronavigation in spine surgery?
  8. How widely used is neuronavigation?

1.  What is neuronavigation?
Using a technology similar to a global positioning system (GPS), neuronavigation provides the surgeon the ability to see a patient’s anatomy in three dimensions and accurately pinpoint a location in the brain or spinal cord with the aid of diagnostic images such as computed tomography (CT) and magnetic resonance (MR), or intra-operative images using the PoleStar® or O-arm™ systems. It also enables surgeons to track instruments in relation to a patient’s anatomy and track the anatomy itself during a surgical procedure.

The term “neuronavigation” is synonymous with image-guided surgery (IGS), computer-assisted/computer-aided surgery (CAS) and neuronavigation.

2.  How does neuronavigation technology work?

You might compare surgical neuronavigation technology to the location and directional tracking systems used for cars and ships today -- it is, in effect, a GPS system for the surgeon. Much as the driver of a car uses the GPS system to find the way on the road, the surgeon depends on these images to confirm the position of his or her instruments in the patient's body.

As the surgeon moves an instrument in the body, its position is precisely calculated. That data is then transferred to a computer in the operating room. The computer then superimposes the position of the instruments as they are used in surgery onto images of the anatomy displayed on a monitor, allowing the surgeon to see the exact placement and direction the instrument is moving.

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3. Why is it beneficial for surgeons to use neuronavigation during surgery?   

Ultimately, using neuronavigation helps the surgeon accurately detect where he or she is working in the patient's body at every moment during surgery.

This capability enables the surgeon to make smaller incisions. When trauma to the body is minimized, the patient may spend less time in recovery and may experience fewer complications.

  • By enabling the surgeon to navigate through the delicate landscape of the sinus or brain more accurately, the surgeon can remove a brain tumor or sinus infection, possibly without impacting healthy tissue. During orthopaedic surgery, neuronavigation helps the surgeon align bones at just the right angle.
  • This precise technology also enables the surgeon to go right to the problem, which may mean the patient spends less time on the operating table.
  • This technology may mean better long-term results with less need for repeat surgeries.

4. In what ways can the use of neuronavigation affect my recovery?
Trauma, pain and scarring can be minimized due to smaller incisions and the surgeon’s increased ability to avoid damaging healthy tissue. The precise technology can also mean better long-term results and decrease the need for repeat surgeries.

5. What steps are involved in a neuronavigation procedure?
There are four broad steps in a neuronavigation procedure. These steps are summarized here, with more detailed information below.

  • A diagnostic image (MRI, CAT Scan) of the patient’s anatomy may be loaded into the computer.
  • The scan is then used to create a 3D model of the patient's anatomy.
  • Just before surgery, the surgeon maps the patient's anatomy to the 3D model using an image-guided probe. (For spinal surgery, Medtronic software can build this model and make the map automatically.) This process is known as registration
  • Using the neuronavigation system as a tool, the surgeon can see the instruments on the computer image and confirm the exact point where she or he is operating.

Step 1 - The radiology technician takes a CAT or MRI scan of the patient.
Usually the evening before or day of the surgery, a radiology technician takes the first essential step -- a CAT or MRI scan of the patient's anatomy. The CAT Scan, which captures bony structures, is used most often for sinus or spine surgery, while an MRI, which creates a clear image of soft tissue, is used more often for brain surgery.
Just as you navigate in a city on the basis of landmarks -- a particularly tall building or a small park -- a surgeon uses landmarks in the image scan. In the case of the sinus or spine, the natural landmarks of the body -- the bones -- show up on a CAT Scan. The surface of the head, however, needs artificial markers because, except for facial features, the head is relatively featureless.
In that case, the technician will put artificial landmarks on the patient's head to serve as markers. These tiny, donut-shaped sponges (known as fiducials) are coated with a special compound that shows up on an MRI scan. If the scan is taken the night before surgery, the patient may be required to wear them overnight because they must stay on until "registration" (described in Step 3).

Step 2 - The surgeon builds a 3D model on the computer.
The surgeon downloads the image data from the scan of the anatomy into the computer.
For brain or sinus surgery, the surgeon uses the data to build a three-dimensional model of the patient's unique anatomy to be viewed on a computer monitor.
For spine surgery, the surgeon may go through this model-building process, unless the hospital uses software from Medtronic, FluoroNav® Spine.
This software makes the images available for immediate use by the surgeon and maps (or registers) them automatically to the patient's body.
(See Step 3 for the details.)

Step 3 - The surgeon maps the computer model to the patient's body (registration).
After anesthesia is administered, but before the start of surgery,
the surgeon maps the patient's anatomy to the 3D model of the scanned information.
This process is known as registration.
The surgeon does this by first touching a "landmark" on the patient with an image-guided pointer or probe. This can either be a natural landmark, a bony structure such as the outer point of the eye or between the two front teeth, or an artificial donut-shaped marker (fiducial). Then he or she touches that point on the screen with the instrument. The camera for the image-guided surgery system transfers a signal from the probe to the computer to "register" the specific location being touched.
Point by point, on the patient's body and then on the monitor, the surgeon builds a correlation between the body and the screen image. By matching the scan to the real anatomy during surgery, the surgeon, using special image-guided instruments, can "see" the location of the instrument tip in the body accurately as he or she operates.

Step 4 - The surgeon uses the image-guided system during surgery. During surgery, the tip of the surgical instruments will be displayed dynamically as cross-hairs in all three of the anatomical views on the monitor.(Remember, the image is three-dimensional.) As the surgeon moves the instruments, the views shift to show their new position. This also enables the surgeon to visualize the proximity of the instruments to critical anatomic structures, such as the brain, carotid arteries, optic nerve, spinal chord, etc.

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6. How do patients benefit from neuronavigation in brain surgery?
Neuronavigation gives surgeons image-guided precision for delicate procedures like tumor removal or Deep Brain Stimulation (DBS). During tumor removal, navigation and intra-operative imaging allow the surgeon to “see” whether he or she has successfully removed the entire tumor and avoid damage to surrounding healthy tissue. During DBS, the surgeon is able to confidently and precisely target the exact point on the brain necessary for the treatment of Parkinson’s disease or other neurological disorders.

7. How do patients benefit from neuronavigation in spine surgery?
Absolute precision is needed in spine surgery because of its proximity and relation to the spinal cord. Navigation helps the surgeon navigate through the bone, while avoiding the spinal cord and other nerves. This not only helps the surgeon perform a minimally invasive procedure, it allows him or her to visualize the exact incision and screw placement and precisely track surgical instruments in relation to anatomy.

8. How widely used is neuronavigation?
More than 2,300 medical facilities worldwide use Medtronic’s neuronavigation systems to improve the precision of the procedures their surgeons perform and raise their patient care to the highest level.

9. Is neuronavigation covered through my insurance or Medicare? Must I pay any additional fees for the neuronavigation system?
Since every patient’s insurance coverage is different, you will need to contact your insurance provider to discuss your specific coverage.

Courtesy of: http://www.medtronic.com/for-healthcare-professionals/business-unit-landing-Page/Navigation

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