Placement of Intraventricular Catheters Using Flexible Electromagnetic Navigation and a Dynamic Reference Frame: A New Technique

Rodt, Thomas; Köppen, G.; Lorenz, Martin; Majdani, Omid; Leinung, Martin; Bartling, Sönke; Kaminsky, Jan; Krauss, Joachim K.

doi:10.1159/000103263

Cited by 21 publications

(17 citation statements)

References 29 publications

(18 reference statements)

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“…It obviates the need for sharp head fixation offering a good alternative to optoelectric techniques, there are no line-of-sight problems, the position of the patient can be changed during surgery, and it allows the use of flexible instruments [24,31,33]. While it was shown to be beneficial especially in the placement of ventricular catheters for different indications [23,24,31,33,43,44], its advantages have been demonstrated also for many other neurosurgical procedures [22,25,26,27,34,45,46,47]. Studies on the accuracy of EM navigation have shown that it is comparable to optoelectric navigation ranging between 0.71-3.51 mm [48] and 0.7-4.4 mm [49].…”

Section: Discussionmentioning

confidence: 99%

“…Movements of the head during surgery do not lead to navigation inaccuracy. Therefore it is especially advantageous in shunt surgery [24,31,33]. …”

Section: Methodsmentioning

confidence: 99%

“…Electromagnetic (EM) navigation which can be performed without rigid head fixation has been used for various indications in neurosurgery [22,23,24,25,26,27,28]. Despite its multiple advantages, however, there is relatively little published experience with this technique in IIH [29,30,31,32], although it might be used much more frequently in daily routine. …”

Section: Introductionmentioning

confidence: 99%

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Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Hermann¹,

Polemikos²,

Heissler³

et al. 2017

Stereotact Funct Neurosurg

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Background: Idiopathic intracranial hypertension (IIH) is characterized by increased cerebrospinal fluid (CSF) pressure and normal or slit ventricles. Lumboperitoneal shunting had been favored by many investigators for CSF diversion in IIH for decades; however, it has been associated with various side effects. Because of the small ventricular size adequate positioning of a ventricular catheter is challenging. Objectives: Here, we investigated the usefulness of electromagnetic (EM)-guided ventricular catheter placement for ventriculoperitoneal shunting in IIH. Methods: Eighteen patients with IIH were included in this study. The age of patients ranged from 5 to 58 years at the time of surgery (mean age: 31.8 years; median: 29 years). There were 2 children (5 and 11 years old) and 16 adults. Inclusion criteria for the study were an established clinical diagnosis of IIH, lack of improvement with medication, and the presence of small ventricles. In all patients EM-navigated placement of the ventricular catheter was performed using real-time tracking of the catheter tip for exact positioning close to the foramen of Monro. Postoperative CT scans were correlated with intraoperative screen shots to validate the position of the catheter. Results: In all patients EM-navigated ventricular catheter placement was achieved with a single pass. There were no intraoperative or postoperative complications. Postoperative imaging confirmed satisfactory positioning of the ventricular catheter. No proximal shunt failure was observed during the follow-up at a mean of 41.5 months (range: 7-90 months, median: 40.5 months). Conclusions: EM-navigated ventricular catheter placement in shunting for IIH is a safe and straightforward technique. It obviates the need for sharp head fixation, the head of the patient can be moved during surgery, and it may reduce the revision rate during follow-up.

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Section: Discussionmentioning

confidence: 99%

“…Movements of the head during surgery do not lead to navigation inaccuracy. Therefore it is especially advantageous in shunt surgery [24,31,33]. …”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Hermann¹,

Polemikos²,

Heissler³

et al. 2017

Stereotact Funct Neurosurg

Self Cite

View full text Add to dashboard Cite

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“…Although high accuracies are required, which usually points to optical tracking as method of choice, a few researchers have navigated neurosurgical interventions using EM tracking [174,134]. In some cases, namely placement of depth electrodes for epilepsy treatment [200] or catheter placement in the cerebral ventricular system [155], line-of-sight is blocked and so EM tracking is the only option to track the instrument. EM tracking also was used during open liver surgery in combination with an optical tracking system [10].…”

Section: A Range Of Applicationmentioning

confidence: 99%

Electromagnetic Tracking in Medicine—A Review of Technology, Validation, and Applications

Franz

Haidegger

Birkfellner

et al. 2014

IEEE Trans. Med. Imaging

384

273

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Abstract-Object tracking is a key enabling technology in the context of computer-assisted medical interventions. Allowing the continuous localization of medical instruments and patient anatomy, it is a prerequisite for providing instrument guidance to subsurface anatomical structures. The only widely used technique that enables real-time tracking of small objects without lineof-sight restrictions is electromagnetic (EM) tracking. While EM tracking has been the subject of many research efforts, clinical applications have been slow to emerge. The aim of this review paper is therefore to provide insight into the future potential and limitations of EM tracking for medical use. We describe the basic working principles of EM tracking systems, list the main sources of error, and summarize the published studies on tracking accuracy, precision and robustness along with the corresponding validation protocols proposed. State-of-the-art approaches to error compensation are also reviewed in depth. Finally, an overview of the clinical applications addressed with EM tracking is given. Throughout the paper, we report not only on scientific progress, but also provide a review on commercial systems. Given the continuous debate on the applicability of EM tracking in medicine, this paper provides a timely overview of the state-of-the-art in the field.

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“…Electromagnetic tracking systems offer many advantages over optical tracking systems, especially in the field of pediatric neurosurgery, such as for insertion of ventriculoperitoneal shunts, electromagnetic navigation-assisted rigid endoscopic procedures, and intraventricular catheter placement. 7,15,19,23) Electromagnetic navigation systems were created in 1991, with a computer-assisted neurosurgical navigational system using a magnetic source and sensor. 12) Since then, many in vivo and in vitro uses have been reported, and registration error as calculated by the various systems currently varies between 0.7 mm and 4.4 mm, showing no difference in accuracy compared with current optical navigation systems.…”

Section: Discussionmentioning

confidence: 99%

Newly Developed Electromagnetic Tracked Flexible Neuroendoscope -Technical Note-

Atsumi

Matsumae

Hirayama

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Flexible endoscopes can be used in areas that are difficult to approach using rigid endoscopes. No current real-time navigation systems identify the tip of the flexible neuroendoscope. We have developed a flexible neuroendoscope mounted with a magnetic field sensor tip position-tracking system and evaluated the accuracy of this magnetic field neuronavigation system. Based on an existing flexible neuroendoscope, we created a prototype with a built-in magnetic field sensor in the tip. A magnetic field measurement device provides a magnetic field with a working volume of 500 × 500 × 500 mm in front of the device. The device consists of a flat field generator that creates a pulsed magnetic field, connected to a system control unit that interfaces with a computer. The magnetic field sensor (1.8 × 9 mm) was sealed in a site 0.9 mm from the endoscope tip. Accuracy of neuroendoscope tracking was measured using a three-dimensional coordinate-measuring machine that measures the position of objects along 3 axes, with an error of about 3 mm. The accuracy for this neuroendoscope with built-in magnetic field sensor was root mean square error of 1.2 mm and standard deviation of 0.5 mm. This magnetic field neuronavigation system enables real-time tracking of the tip of the flexible neuroendoscope. Application of this flexible neuroendoscope to intraoperative navigation appears promising, and may provide new advantages for minimally invasive endoscopic surgery.

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Placement of Intraventricular Catheters Using Flexible Electromagnetic Navigation and a Dynamic Reference Frame: A New Technique

Cited by 21 publications

References 29 publications

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Shunt Surgery in Idiopathic Intracranial Hypertension Aided by Electromagnetic Navigation

Electromagnetic Tracking in Medicine—A Review of Technology, Validation, and Applications

Newly Developed Electromagnetic Tracked Flexible Neuroendoscope -Technical Note-

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