As he prepares for delicate brain surgery, neurosurgeon Paul Camarata, MD, of Saint Luke's Hospital's Mid America Brain and Stroke Institute, looks into the microscope suspended above the resting patient's head. In the microscope, superimposed over the magnified image, is a transparent green shape, symbolising the tumour that Dr. Camarata will remove, along with a smaller red globule signifying ventricles that he should avoid with the scalpel.
Minutes earlier, Dr. Camarata had scanned the patient's head using an infrared laser, not unlike a television remote control, to enable a new piece of computerised imaging technology, called the BrainLab VectorVision, to map the surface anatomy of the patient's head.
A monitor at Dr. Camarata's side shows the resulting three-dimensional view of the patient's head, the green and red blobs, and a coloured line signifying the angle of the view of the microscope. When Dr. Camarata begins surgery, other lines will appear to show where his scalpel and other tools are placed in relation to the tumour. Using the new VectorVision technology, there is no doubt of the shortest, safest path Dr. Camarata must take to reach and remove the patient's brain tumour.
"In the past, the surgeon had to take a best guess at where the tumour was, and how to avoid delicate tissues, based on a two-dimensional image", stated Dr. Camarata. "Now we can see exactly where the tumour is, as well as the tissues to avoid." Other advantages of the new technology include the ability to make a much smaller incision and remove less tissue than before. "This tool helps us to take a smaller path through the brain, so we disturb less healthy brain tissue", stated Dr. Camarata. "This is the wave of the future. It is so much more accurate."
The technology is wireless. Above the patient stands an infrared camera that feeds information about the location of Dr. Camarata's tools to the monitor, which translates into the coloured lines. Guiding buttons on either side of the microscope's eyepiece allow Dr. Camarata to zoom in or out, depending on the view he desires. The ensemble looks incongruously like an arcade videogame used to seek and destroy a deadly tumour buried beneath layers of tender, healthy brain tissue.
The BrainLab navigation system and the Siemens C-arm SIREMOBIL Iso-C3D were first used on July 8, 2002 by the Salzburg Hospital's Trauma Surgery Center for the placement of pedicle screws. The surgeons at Salzburg Hospital agree that the VectorVision fluoro 3D image-guided surgery system is extremely beneficial, fast and easy to use since the screw's position can be planned on-line in the 3D images provided by the c-arm. In addition, the screw's canal can be easily prepared by navigating the standard hospital drill.
With the Siemens C-arm SIREMOBIL Iso-C3D, a 3D data set and axial slices can be reconstructed from a series of fluoro images which have been taken from different angles. With this technology, image quality comparable to CT scans can be achieved.
The integration of the C-arm with the VectorVision system, allows volumetric data to be immediately obtained and used for the navigation of surgical instruments. The integrated and automated registration process saves time and provides high navigation accuracy. The integration of these systems combines the clinically proven capabilities of BrainLab's CT-based spine software with the work flow benefits of the new Siemens Iso-C3D system.