Sinus And Skull Base Surgery

The master console consists of an image processing computer that generates a true 3-dimensional image with depth of field; the view port where the surgeon views the image; foot pedals to control electro cautery, camera focus, instrument/camera arm clutches, and master control grips that drive the servant robotic arms at the patient’s side.6 The instruments are cable driven and provide 7 degrees of freedom. This system displays its 3-dimensional image above the hands of the surgeon so that it gives the surgeon the illusion that the tips of the instruments are an extension of the control grips, thus giving the impression of being at the surgical site. (Lanfranco, et al., 2004, Para. 12)

Technological advancements contribute to the medical field more than storing information, however. Breakthroughs in technology allow surgeons improved methods in operations all over the world. Neurosurgeons at UC San Diego Health system found a way to revolutionize brain tumor operation. The team of scientists integrated 3D imagery, computer simulation and upgraded surgical tools to perform a very complex surgery through a miniscule incision (Carr). In comparison to making a large incision and removing an even larger section of the skull, the new procedure reduced the operation site, “[decreasing] the risk of the surgery and

Many people don’t realize that sinus conditions can often be treated quite successfully. A careful examination combined with special imaging techniques can reveal the reasons for these sinus conditions. They can be the result of three main problems: allergies and pollutants that thicken the nasal tissues and cause nasal blockage; poor nasal breathing, which can worsen sinus conditions; or closed sinus openings which prevent adequate drainage of the sinuses. The new specialized techniques which have been recently developed use tiny endoscopes, to relieve specific blockage for the nasal passages. The treatment is done as an outpatient and does not require nasal packing. Patients can usually return to work in a few

Endoscopic skull base surgery has very few incisions with the doctor using an endoscope to remove the tumor at the skulls base and/or brain by using the nasal cavity. This procedure provides a more effective removal of the tumor. Laser Interstitial Thermal therapy provides treatment for brain tumor and spine tumors. It is done by a probe being inserted into the tumor and then heating the tumor to extreme temperatures to kill it. Brain tumor such as gliomas and metastases can have this procedure used to treat them. Additionally, it helps reach hard to reach, deep set tumors, or irregularly shaped tumors and if the patient does not respond well to radiation. This procedure has also been used for spinal tumors. This is mostly used when the normal surgery techniques are not available. Furthermore, another type of procedure is the minimally invasive spinal stabilization which is a small (usually one or more half- inch) incision used for the surgery. It helps provide less blood loss as well as lowers infection rate with a shorter hospital stay and faster

Chordomas of the skull base represent significant challenges due to their midline position and their ability to engulf critical neurovascular structures located around them. In addition to these location issues, their biology represents significant challenges, as notocordal rests located throughout the clivus, often remote from the visible lesion, have the propensity to grow and recur. Both of these features are critical for the skull base surgeon, the former in determining the surgical approach and trajectory and the latter in deciding on the surgical goals and intentions of treatment. For more than a decade, lateral and paramedian approaches have been traditionally the mainstay for surgical access and have provided valuable corridors. These have included transbasal (12), trans-septal trans-sphenoidal (13), transmaxillary (14), facial translocation, (15), transoral with or without mandible split (16), transcervical-transclival, and anterior cervical approaches. These anterior and lateral approaches toward a centrally located chordoma carry the potential morbidity of manipulating neurovascular structures in the way to lesion. The cited data report gross total resection rates that vary widely, ranging from 44 to 83%. The corresponding neurological morbidity rates are equally variable, ranging from 0 to 80%, and vascular injuries are reported at 9 to 12%. CSF leak rates are reported to range from 8.3 to 30% (17-19).

Intellijoint Surgical in less than five years enabled a tool for surgeons to make accurate measurements when doing hip replacement surgeries.

Although brain surgery was the first clinical target for FUS, it provides special challenges due to the higher attenuation of ultrasound of skull bone. Also the lack of accurate targeting and energy deposition control prevented its clinical use in the central nervous system. Bone density also affect the speed of sound. If use conventional focused transducers, It would be difficult to obtain a sharp focal spot through an intact skull. Therefore for earlier clinical trials, there was always removed a part of skull bone to provide an good acoustic access to the brain. The skull problem has been solved by two key developments. And clinical brain treatment is possible now. It was discovered that using low frequency phased arrays with common element sizes can produce a sharp focus through the skull. Or the skull heating problem can be overcome by using phased array applicators with large enough surface areas. It was proved that modern medical instrument can provide enough information to allow precise focusing[31]. InSightec developed a complete system designed for clinical FUS surgery. This technique has been tested in three patients to determine the maximum intensity that could be delivered through the skull bone [29]. Three brain tumor patients in Boston proved that sharp focusing could be

Robot assisted surgeries are surgical procedures which utilize a robotic system controlled by a physician or a surgeon (via a computer). The robotic system is equipped with a camera to help the operator see the organ being operated upon. These systems are known for their precision, accuracy, delicacy, and overall efficient controlling options. [3] Since their invention, they have been, and currently are used in urological, neurological, endoscopic, cardiovascular, and gynecological surgeries. Robot assisted surgeries have been in practice since 1990 after the approval of the technology by the Food and Drug Administration (FDA), although the history of Robot assisted surgery dates back to 1985 when it was first used to perform a neurological biopsy. [1]

The paranasal sinuses are air-filled spaces situated in the bones of the skull and bones of the facial region. The different anatomical dimensions of the paranasal sinuses can be obtained from plain radiograph and Computed Tomography (CT) images (Pernilla, et al., 2010). There are four sinuses that can be found in the bone of the face and skull of humans and these sinuses consist of the frontal, the ethmoid, maxillary and the sphenoid sinuses. This study is therefore focused on one aspect of the paranasal sinuses: the frontal sinus (left and right sinuses). Sinuses are mucosa-lined air spaces in the bone of the face and skull. The frontal sinuses are paired lobulated cavities situated posterior to the supercilliary arches in the frontal bone

The frontal sinus is the last of the paranasal sinuses to develop. It lighten the skull and cushion the brain from

CT provides superior spatial resolution and image reconstruction compared to echo and can therefore accurately characterize the anatomical properties.18 The shape of the LAA can be ascertained by viewing the volume rendered images and are classified into four distinct shapes as described by DiBiase et al. These include the windsock (single major lobe without significant bend), chicken-wing (obvious bend in the body of LAA), cactus (major central lobe with multiple secondary lobes), and cauliflower (short LAA body that branches into several lobes) shapes. Ascertainment of the LAA shape may help inform the operator on the level of complexity of device implantation. The choice and size of LAA occluder device itself is dictated by the dimension and shape of the anatomical orifice of the LAA.19 Using multi-planar reformat (MPR) images, a cross-sectional orthogonal “end-on” view is created to measure the widest and narrowest diameters of the LAA ostium. The maximum depth of the LAA is measured from the orifice to the distal tip of the desired lobe. An important feature with implantation of the WATCHMAN is that the depth of the distal lobe has to be as deep as the diameter of device chosen.

Parotidectomy is one of the most frequently performed surgical procedure in oral and maxillofacial surgery, and can result in complications that can be highly detrimental to the patient, including facial nerve paralysis, frey’s syndrom, and salivary fistula.

Various setup options will be explored to examine which systems provide the most reliable results. These setup options involve a ToF camera, stereo webcams and stereo microscopes. Multi-camera setups will be considered as the needle and tools need to be tracked in both coarse and fine movements.

This imaging system allows the surgeon to see an enhanced 3-dimensional view of the operative field and it provides direct eye-hand-instrument alignment and natural depth perception. This is possible through the use of a dual lens endoscope with two high-resolution cameras.

Technology is transforming the medical field with the design of robotic devices and multifaceted imaging. Even though these developments have made operations much less invasive, robotic systems have their own disadvantages that prevent them from replacing surgeons all together. Minimally Invasive Surgery (MIS) is a broad notion encompassing a lot of common procedures that existed prior to the introduction of robots. It refers to general procedures that keep away from long cuts by entering the body through small, usually about 1cm, entry incisions, through which surgeons use long-handled instruments to operate on tissue inside the body. Such operations are directed by viewing equipment and, therefore, do not automatically need the use of a robot. Yet, it is not incorrect to say that computer-assisted and robotic surgeries are categories that fall under minimally invasive surgery (Robotic Surgery, n.d.).