Track 6. Technological innovations in biomedical training and practice Authors: Jesús M Gonçalves, M J Sanchez-Ledesma, P Ruisoto, M Jaramillo, J J Jimenez and J A Juanes

1. NEURONAVIGATION SOFTWARE
TO VISUALIZE AND SURGICALLY
APPROACH BRAIN STRUCTURES
MAURICIO JARAMILLO PIMIENTA
Neurosurgery - Compl. Asist. Universitario De Salamanca
University Of Salamanca
JESÚS Mª GONÇALVES, Mª JOSÉ SÁNCHEZ-LEDESMA,
PABLO RUISOTO, JOSÉ JAVIER JIMÉNEZ, JUAN A. JUANES
Visualmed Systems Group. University Of Salamanca

2. Introduction
u A Neuronavigator is a
computer system that
allows the surgeon to see
and follow the position of
the instruments which he
or she is handling on
screen during a surgical
procedure

3. OBJECTIVES
u To show the visualization possibilities of brain structures that these support
techniques provide in the surgical intervention performed.
u To evaluate the possibilities its software and visualization system offer.

4. METHODOLOGY
Medtronic StealthStation® S8®
neuronavigation equipment

5. u PRESURGICAL PLANIFICATION
AT THE WORKSTATION
u USER INTERFACE OF THE STEALTHSTATION S8

6. Results
• Tasks before the navigation:
• Calibrating the stereo system
• Pattern-instrument association
• Study-patient registry
• During the navigation, the system
cyclically executes the following
blocks:
• Image capture
• Image characteristics
detection

8. Pointer´s Position and Pattern

9. Reference systems
u To follow the pointer during surgery
and show its position on the images
of a study according to its position in
surgery simultaneously, it is necessary
to connect the measures taken in
the different coordinate systems. This
process requires registration and
calibration processes.

10. STEREO
VISION
Coordinates
Of The
Preoperative
Study
Physical
Position Of
The Patient
Three-
dimensional
Coordinates
Of The
Pointer

11. Discussion
u In order to be used reliably, these surgical navigation systems must
be as accurate as possible, preferably in the range of a voxel size of
the images used.
u Most of the systems that are used take preoperative 3D data and
record it, matching it to the patient’s coordinate system.
u However, they rest on the assumption that the organs operated on
are rigid and, therefore, are subject to error due to soft tissue
deformation

12. Advantages
u Smaller size linear incisions
u Accurately centered
craniotomies, even smaller than
the lesion size
u Ability to find millimeter-sized
lesions, which previously required
a stereotaxic procedure lasting
several hours
u Shorter surgical times and lower
risk for important functional areas
as well as greater resection
radicality.

13. Disadvantages
u "BRAIN-SHIFT”
u To solve this problem, the possibility
of determining and tracking
superficial deformations during
surgery can be achieved by
targeting external anatomical
regions of interest or by monitoring
significant internal structures using
ultrasound images.

14. Conclusion
u Neuronavigation has been a key step in the integration of functions
and abilities, but we can still make progress. The techniques based
on virtual and augmented reality can help to further reduce the
possibilities of error by transforming neurosurgery and improving
patient outcomes