St. Catherine of Siena Medical Center has acquired a new and exciting technology, which allows surgeons to use CAT-scan and MRI pictures to navigate with instruments in the human body.

This technology allows for greatly improved pre-surgical planning of the surgical goals and approach. In brain surgery the precision in removal of lesions (tumors, blood clots, etc.) is greatly enhanced and the potential for neurological deficit is minimized. In spine surgery the technique allows for greater precision in the insertion of screws to fixate the spine in spinal instrumentation procedures.

In ENT surgery, the system aides in the navigation of endoscopic sinus surgery.

St. Catherine of Siena Medical Center has acquired the VectorVision® (BrainLab) [Computer Assisted Minimally Invasive Surgery System], which is FDA approved for intracranial, spinal and ENT procedures.

All systems function on the same principle of first creating a scan (MRI or CAT) of the body part (head or spine) usually with markers placed on the external surface. In the operating room these scans are displayed on a computer screen in 3-D fashion with the external markers visualized. A infra-red camera tracks the position in "space" of instruments, outfitted with infra-red light emitting diodes. The instrument's position is calibrated (or registered) by a process of first selecting the visualized external marks on the scan and than touching the external marks placed on the patient's head. Thereafter the computer knows at all times the exact position of the tip of a probe, dissecting instrument or suction instrument in relationship to anatomical structures in the head. In spinal cases, interior bony landmarks are used for registration, rather than external marks placed on the skin.

Applications

This methodology can be used to perform stereotactic biopsies of the brain without the need to place a stereotactic frame on the head of the patient. No more screws that have to be inserted into the skull! In this fashion stereotactic biopsies can be done through small openings (burr holes) while avoiding the need for open craniotomies. It also enables the surgeon to biopsy at much greater depth and in more sensitive areas without significantly increasing the danger for causing further brain damage.

The system is a great adjunct to the surgery of malignant brain tumors. One of the major challenges in neurosurgery is the removal of a primary brain tumor which is essentially a part of the brain itself. These neoplasms usually originate from the brain cells themselves and can infiltrate "good" brain with finger-like outgrowths. During surgery it is often impossible to determine, even with a microscope, where tumor ends and normal brain begins. In order to avoid removal of normal brain with increased risk toward causing neurological damage, neurosurgeons tend to be less aggressive in the removal of these neoplasms and leave significant tumor behind. With the help of the VectorVision® system, the margins of the tumor can be visualized with a MRI picture on a computer screen and the surgical instruments navigated to stop exactly at the area where normal brain begins. In this way a more radical resection can be accomplished, while minimizing the risk of neurological deficit.

The system also allows for greatly improved precision in the preoperative planning of an approach to a brain lesion. The point of entry and trajectory to a surgical target can be determined in advance to avoid sensitive structures. In this way it facilitates the placement of shunt catheters in brain chambers for hydrocephalus and needle aspirations of cysts and abscesses. In endoscopic procedures it helps in the placement of small fibrooptic scopes to visualize lesions in cysts and brain chambers.