Neuro-Navigation, also termed frameless stereotactic surgery, is the ability to perform real-time intra-operative guidance during brain and/or spinal surgery. This ability increases the accuracy and safety in neurosurgery. Indeed such technology is becoming a standard in neurosurgery. At Apollo Hospitals Navi Mumbai, we use Brain Lab Frameless neuro navigation Systems. Such technology is able to guide the surgeon to the surgical targets without the use of external frames. The stereotactic or localization aspect of this technology is based on external or surface fiducials and internal or anatomical landmarks.
The major role of frameless systems or Neuro-navigation in neurosurgery is in brain surgery. Such localization can limit the size of the skull opening or craniotomy and safely remove intra-axial lesions like brain tumors. Thus, the frameless stereotactic systems have been used primarily for tumor resection. Such systems are especially useful in accurately localizing, and then resecting tumors near important areas of the brain such as the motor strip. The Radionics CRW System in Apollo Hospitals is fully equipped with range of accessories necessary for performing Frame Based Stereotactic Surgery.
Microsurgical Instrumentation: Two complete sets of Microsurgical Instruments are available at each Centre of Excellence for skilled surgeons to carry out the full range of microsurgery for neurosurgery, as well as spinal surgery.
More to know about Stereotactic Surgery
The concept of stereotactic brain surgery is simple. This technique uses images of the brain to guide the surgeon to a target within the brain. Another name for this is neuro-navigation. This technique may utilize an external frame attached to the head (frame-based) or imaging markers attached to the scalp (frameless or image-guided surgery) to orient the surgeon in his approach. The term “stereotactic” was coined from Greek and Latin roots meaning “touch in space.”
Frame-based stereotactic surgery is a technique where a light-weight frame is attached to the head using local anaesthesia. The head is imaged by CT, MR or angiography to identify the target in relationship to the external frame. Since both the frame and the target are “seen” in the images, the distance of the target from reference points on the frame can be measure in three dimensions. Surgical apparatus attached to the head frame can be adjusted to the three-dimensional coordinates of the target, and the target can be accurately approached by the surgeon.
It is also used for stereotactic brain biopsy. Deep tumours within the brain may be difficult and dangerous to approach by an open surgery. Using a stereotactic biopsy apparatus fixed on the head frame and adjusted to the target coordinates, a biopsy probe is passed through a small hole in the skull to sample tissue for diagnosis. This technique is also used to place electrodes in the deep brain to treat movement disorders such as Parkinson’s disease.
Frameless stereotactic surgery on the other hand, relies on fiducial markers which are taped to the scalp before the brain is imaged. In the operating room, the orientation of these markers is used to register the computer containing the brain images. Once registration is completed, the computer can show the relationship of the surgical instruments to the imaged brain. Frameless or image guided surgery is very helpful for the accurate approach and removal of large brain tumours.
What is Brainlab?
Similar to a car or mobile phone global positioning system, surgical navigation continuously tracks surgical instrumentation in relation to actual patient anatomy and displays the relationship, in real time, on a software screen during surgery.
Brainlab software, designed for both routine and complex surgical procedures, contains intuitive user interface that provides accelerated workflows for image-guided surgery.