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ABSTRACT: The authors describe a technique for minimally invasive anterior vertebroplasty for treating metastatic disease of the C-2 vertebra and discuss its application in 2 cases. After a 2-cm lateral neck incision is made, blunt dissection is performed toward the anterior inferior endplate of the C-2 vertebra. An 11-gauge needle is introduced through a tubular sheath and tapped into the inferior endplate of C-2, with biplanar fluoroscopy being performed to confirm position. The needle is subsequently advanced across the fracture line and into the odontoid process. Under fluoroscopic guidance, 2 ml of methylmethacrylate is injected into the odontoid process and vertebral body. This method is advantageous as 1) hyperextension of the neck is not performed, 2) the chance of inadvertent neurovascular or submandibular gland injury is minimized, 3) the possibility of cement leakage is decreased, and 4) hemostasis is better achieved under direct vision.
Neurosurgical FOCUS 02/2008; 25(2):E4. · 2.87 Impact Factor
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Gulsheen Kaur,
Jun Tan,
Mohammed Alam,
Vipin Chaudhary,
Dingguo Chen,
Ming Dong, Hazem Eltahawy,
Farshad Fotouhi,
Christopher Gammage,
Jason Gong, [......],
Joseph Landman,
Jong Lee,
Qing Hang Li,
Hanping Lufei,
Michael Morse,
Jignesh Patel,
Ishwar Sethi,
Weisong Shi,
King Yang,
Zhiming Zhang
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ABSTRACT: CASMIL aims to develop a cost-effective and efficient approach to monitor and predict deformation during surgery, allowing accurate, and real-time intra-operative information to be provided reliably to the surgeon.
CASMIL is a comprehensive Image-guided Neurosurgery System with extensive novel features. It is an integration of various modules including rigid and non-rigid body co-registration (image-image, image-atlas, and image-patient), automated 3D segmentation, brain shift predictor, knowledge based query tools, intelligent planning, and augmented reality. One of the vital and unique modules is the Intelligent Planning module, which displays the best surgical corridor on the computer screen based on tumor location, captured surgeon knowledge, and predicted brain shift using patient specific Finite Element Model. Also, it has multi-level parallel computing to provide near real-time interaction with iMRI (Intra-operative MRI). In addition, it has been securely web-enabled and optimized for remote web and PDA access.
A version of this system is being used and tested using real patient data and is expected to be in use in the operating room at the Detroit Medical Center in the first half of 2006.
CASMIL is currently under development and is targeted for minimally invasive surgeries. With minimal changes to the design, it can be easily extended and made available for other surgical procedures.
International Journal of Medical Robotics and Computer Assisted Surgery 07/2006; 2(2):123-38. · 1.59 Impact Factor
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ABSTRACT: The success of subthalamic nucleus (STN) surgery for Parkinson's disease depends on accuracy in target determination. The objective of this study was to determine which of the following techniques was most accurate and precise in identifying the location for stimulation in STN deep brain stimulation surgery that is most clinically effective: direct targeting, indirect targeting using the positions of the anterior and posterior commissures, or a technique using the red nucleus (RN) as an internal fiducial marker.
We reviewed 14 patients with Parkinson's disease treated with bilateral STN deep brain stimulation (28 STN targets). Electrode implantation was based on direct and indirect targeting using two-dimensional magnetic resonance imaging with refinement using microelectrode recording. Optimal settings, including the contacts used, were determined during the clinical follow-up. The position of the best contact was defined with postoperative magnetic resonance imaging. This location was compared with the modified direct, indirect, and RN-based targets. The mean distances between the targets and the final position of the optimal contact were calculated. The accuracy and variance of each target were analyzed.
The mean position of the best contact was x = 12.12 (standard deviation [SD], 1.45 mm), y = -2.41 (SD, 1.63 mm), and z = -2.39 (SD, 1.49 mm) relative to the midcommissural point. The mean distance between the optimal contact position and the planned target was 3.19 mm (SD, 1.19 mm) using the RN-based method, 3.42 mm (SD, 1.34 mm) using indirect targeting, and 4.66 mm (SD, 1.33 mm) using a modified direct target. The mean distance between the optimal contact and the RN-based target was significantly smaller than the mean distance between the optimal contact and the direct target (post hoc with Tamhane's correction, P < 0.001) but not between the optimal contact and the indirect target. The RN-based target had the smallest variance (F test, P < 0.001), indicating greater precision.
The use of the RN as an internal fiducial marker for targeting the optimal region of STN stimulation was reliable and closely approximates the position of the electrode contact that provides the optimal clinical results.
Neurosurgery 04/2005; 56(2 Suppl):360-8; discussion 360-8. · 2.79 Impact Factor
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ABSTRACT: Deep brain stimulation (DBS) produces striking effects in patients with various disorders including Parkinson's disease and dystonia, yet its precise mechanism of action is not clear. Because the clinical benefits of lesioning target structures such as the thalamus, globus pallidus and subthalamic nucleus appear to be similar to those achieved by chronic application of stimulation at these structures, it has been surmized that deep brain stimulation produces a functional inactivation or block of the target. This simplistic proposal has supporting and detracting evidence. In the present work we consider the mechanism of action of DBS and provide arguments for and against the stimulation or inhibition of target neural structures.
Supplements to Clinical neurophysiology 02/2004; 57:733-6.
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Gulsheen Kaur,
Jun Tan,
Mohammed Alam,
Vipin Chaudhary,
Dingguo Chen,
Ming Dong, Hazem Eltahawy,
Farshad Fotouhi,
Christopher Gammage,
Jason Gong, [......],
Joseph Landman,
Jong Lee,
Qing Hang Li,
Hanping Lufei,
Michael Morse,
Jignesh Patel,
Ishwar Sethi,
Weisong Shi,
King Yang,
Zhiming Zhang
[show abstract]
[hide abstract]
ABSTRACT: Background CASMIL aims to develop a cost-effective and efficient approach to monitor and predict deformation during surgery, allowing accurate, and real-time intra-operative information to be provided reliably to the surgeon. Method CASMIL is a comprehensive Image-guided Neurosurgery System with extensive novel features. It is an integration of various modules including rigid and non-rigid body co-registration (image-image, image-atlas, and image-patient), automated 3D segmentation, brain shift predictor, knowledge based query tools, intelligent planning , and augmented reality. One of the vital and unique modules is the Intelligent Planning module, which displays the best surgical corridor on the computer screen based on tumor location, captured surgeon knowledge, and predicted brain shift using patient specific Finite Element Model. Also, it has multi-level parallel computing to provide near real-time interaction with iMRI (Intra-operative MRI). In addition, it has been securely web-enabled and optimized for remote web and PDA access. Results A version of this system is being used and tested using real patient data and is expected to be in use in the operating room at the Detroit Medical Center in the first half of 2006. Conclusion CASMIL is currently under development and is targeted for minimally invasive surgeries. With minimal changes to the design, it can be easily extended and made available for other surgical procedures. Copyright © 2006 John Wiley & Sons, Ltd. Peer Reviewed http://deepblue.lib.umich.edu/bitstream/2027.42/55246/1/87_ftp.pdf
