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Safer, easier brain surgery

(June 7, 1998 07:20 a.m. EDT http://www.nando.net) -- A new computer-guided
system that combines virtual reality technology with the skills of a surgeon's
hands is allowing safer surgery and shorter recovery times for neurosurgical
patients.

Developed by the German company BrainLAB, the VectorVision computer system
maps a patient's brain and displays it as a three-dimensional image on a
computer screen.

The surgeon operates while viewing the image on the screen, which serves as a
visual guide.

According to Dr. Eugenio Vargas, a neurosurgeon at Methodist Medical Center,
of Oak Ridge, Tenn., the system gives surgeons added precision by allowing
them to view the exact position of their scalpels and other instruments in
relation to the inside of a patient's brain.

"It's much like using a road map to find the quickest, most direct route to
where you're going," said Vargas.

Methodist Medical Center acquired the system in March and has so far used it
with four patients.

While the ability to visualize intracranial structures non-invasively has been
revolutionized by advancements in diagnostic imaging, until VectorVision,
three-dimensional images were unavailable to the surgeon.

That meant the surgeon had to mentally apply the diagnostic images to the
three-dimensional patient anatomy.

VectorVision uses two cameras that constantly track small reflective spheres
attached to surgical instruments.

The images are relayed to a computer screen programmed to display three-
dimensional images of the brain and instruments.

The computer also allows physicians to see exactly where the tumor or
malformation is in relation to the instruments.

In addition, the physician can work through smaller incisions.

And the system is wireless, freeing the physician to focus on the patient and
procedure rather than technology.

"Because the system allows you to rehearse with a virtual tip prior to
cutting, you can plan the best point of entry and best angle," said Vargas.

"Armed with this information, you can avoid damage to other areas of the
brain."

Prior to surgery, five adhesive markers are attached to the patient's scalp
near where the surgery will be performed.

In the past, a frame that looks much like a drum would have been attached to
the patient's head with a series of screws.

The markers allow registration on the computer software.

Before using the image guided surgery system, the physician simply touches his
probe to each marker to complete full registration.

This reduces overall patient registration time to a few seconds as opposed to
15 minutes or more with the previous method.

Patient data obtained from CT, MR and other imaging technology is fed to the
computer system along with the physician's strategic plan for the optimal
surgical approach.

That can be done either the night before or just before surgery.

This information is then used to create the three-dimensional image of the
patient's anatomy and the tumor or other malformation.

It's the information the physician uses to calculate distances within the
brain and how big a lesion is.

With the image displayed on the computer screen, the surgeon makes a small
incision at the point of entry and performs the surgery while watching the
screen.

"Where before I had to make a larger incision, now I know the exact point of
entry and can go in through a much smaller incision with a higher degree of
safety to remove the lesion," said Vargas.

"Translated, that means more accuracy, finer detail and time savings."


AMY SMITH writes for the News-Sentinel in Knoxville, Tenn.
Distributed by Scripps Howard News Service.
Copyright 1998 Nando.net
Copyright 1998 Scripps Howard

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