By Marwan I. Hariz M.D., Ph.D. (auth.), C. B. Ostertag, D. G. T. Thomas, A. Bosch, B. Linderoth, G. Broggi (eds.)
Neurosurgery o/the destiny: desktops and Robots in medical Neurosurgical perform and in education - a Philosophical trip into the longer term Many trendy neurosurgeons think that they already receive sturdy ends up in operative surgical procedure with the good thing about the working microscope and different aids that have turn into to be had within the final 3 many years and that the creation of desktops and robots to the working theatre is superfluous. besides the fact that, it really is transparent from analogy with the functionality of the airline pilot, one other occupation the place there are nice calls for on guide ability and on spatial knowledge, that those units do have a lot to provide neurosurgery. Classical neurosurgery, during Cushing, Dandy and Scarff, used to be in response to a 3 dimensional photograph of the patient's mind shaped within the surgeon's brain and infrequently illustrated in based drawings. Such photographs have been in keeping with neuroradiological reports by way of pneumoencephalography, ventriculography or by way of angiography. regularly those stud ies confirmed the presence and place of a lesion by way of displacement of standard mind constructions and the image used to be equipped up via interference. This used to be then switched over via the skilled neurosurgeon right into a plan for the craniotomy web site and the trajectory of the surgical strategy. as soon as the mind used to be uncovered additional pre-operative details used to be acquired by way of visible inspection and through palpation with the mind needle. those classical varieties ofneuroradiology have principally been outdated by way of computerised tomography and by way of magnetic resonance imaging.
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This quantity got here out of discussions with Professeur Michel Fardeau my long-time colleague in Paris and now Directeur of the Institut de Myologie on the Hopital Pitie-Salpetriere there, and Professeur Emeritus Rene Couteaux, Universite de Paris VI. in the course of my sabbatical 12 months 1994-95, as Professeur de L'Academie des Sciences and Chaire Elf Aquitaine in Paris, Professeur Couteaux and that i had a few discussions, centering at the improvement of the sphere of synaptology from his viewpoint as one that had skilled some of the major advances in the course of his energetic expert profession.
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Additional info for Advances in Stereotactic and Functional Neurosurgery 12: Proceedings of the 12th Meeting of the European Society for Stereotactic and Functional Neurosurgery, Milan 1996
At each pyramid level the solution from the previous pyramid level is used as an initial estimate. The algorithm computes 3D Laplacian, Gaussian or edge pyramids. A direct hierarchical method is used to do the minimization [5, 11, 15, 16] (Fig. 6). There has been wide clinical application of interactive use of computed images. In previous work, threepoint transformation of image data has been used in either pre-operative imaging with or without the stereotactic frame to be co-registered with perioperative images or to localize anatomical structures at the time of surgery [3, 4,6,9,12].
Important issues that need to be addressed in future studies include: (I) the optimal location and size of the pallidal lesion, (2) the duration of clinical improvements, (3) when to operate during the course of the illness, and, (4) because the effects are predominantly contralateral, the safety and efficacy of bilateral surgery. Given the variability of the disease course, surgical variations and day-to-day fluctuations in patient performances, as well as the effects of patient and physician expectations on clinical evaluations, the authors recommend the adoption of blinded and randomized assessments of videotaped UPDRS examinations in the evaluation of the outcome of surgical interventions for PD.
The authors feel the same concern for volumetric analysis in functional stereotaxy such as pallidotomy. The ability to superimpose the pre- and postoperative 3D volume data sets allows analysis of accuracy in the lesion location in relation to preoperative coordinates. Further, it permits localization of electrophysiological data in 3D volume. This has a particular implication for the number of electrode passes for recording the 32 R. M. Lehman et al. A B c o Fig. 3. (A-D) Post-operative MR images in multiplanar 2D and 3D volume surface rendered views.