title: Magnetic field guided endoscopic dissection through a burr hole may avoid more invasive craniotomies. A preliminary report.
abstract: The neuroendoscope, coupled with radiofrequency or laser dissecting tools, can effectively resect obstructing membranes, biopsy and debulk tumor, and evacuate hematomas when the pathology is within the ventricular system. This less invasive approach through a burr hole usually avoids craniotomies. When the abnormal condition is within parenchyma or in the presence of opacifying bloody fluid, landmarks are not recognizable and the neurosurgeon quickly becomes disoriented. A more extensive craniotomy or a stereotaxic-guided procedure is then necessary. We describe our preliminary experience with a geographic intracranial navigation system using realtime measurement of electromagnetic field strength in multiple planes to precisely indicate the position of the tip of the endoscope. A transmitting antenna is positioned beneath the patient's head. A 1.5 centimeter cubic antenna receiver is mounted upon a lenscope with instrument channel. The scope is guided into the surgical field after insertion through a burr hole. A square wave pulsed electromagnetic field measurement is made 140 times per second with correction for the earth's magnetic field once per second. Intracranial position data for the dissecting tip in regard to X, Y, Z, pitch, roll and yaw are output to a digitized computer map of the patient's MRI or CT scan. Also displayed on the computer screen is the video image from the endoscope. The neurosurgeon thus has simultaneous realtime geographic and near-field localization as he dissects. Electromagnetic field guided accuracy is within 2.0 mm inside the allowable 24 inch working sphere about the patient's head. Coupled with near-field video precision, accuracy is within 1 mm of recognizable dissection planes.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Phoenix Children's Hospital, Arizona, USA.
authors.forename: K H
authors.initials: KH
authors.lastname: Manwaring
authors.forename: M L
authors.initials: ML
authors.lastname: Manwaring
authors.forename: S D
authors.initials: SD
authors.lastname: Moss
mesh_terms: D001927:Brain Diseases / Q000601:surgery*; D001932:Brain Neoplasms / Q000601:surgery*; D003399:Craniotomy / Q000295:instrumentation*; D004574:Electromagnetic Fields; D019723:Endoscopes; D004867:Equipment Design; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation; D008279:Magnetic Resonance Imaging / Q000295:instrumentation; D012984:Software; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D013813:Therapy, Computer-Assisted / Q000295:instrumentation; D014057:Tomography, X-Ray Computed / Q000295:instrumentation; D014207:Trephining / Q000295:instrumentation*