Osipov Lev, prof., PKF “IZOMED” Ltd., Moscow
NEW TECHNOLOGY OF TRANSCRANIAL ULTRASOUND NAVIGATION FOR MINIMALLY INVASIVE BRAIN NEUROSURGERY WITH REAL TIME MONITORING OF MANIPULATOR AFFECTING
Neurosurgery makes use of preoperative imaging as a rule MR or CT imaging to visualize pathology and inform surgical planning. Preoperative imaging for neuronavigation, however, is diminished by the well‐characterized phenomenon of brain shift, in which the brain deforms intraoperatively as a result of craniotomy, gravity, tumor resection, cerebrospinal fluid (CSF) drainage, and many other factors. As such, there is a need for updated intraoperative information that accurately reflects intraoperative conditions in real time. Intraoperative ultrasound has allowed neurosurgeons to update operative plans major workflow interruption. Ultrasound technology since its introduction has resulted in superior imaging quality, smaller probes, and high rate of information renewal. The introduction of imaging modalities, such as 3‐dimensional ultrasound, contrast‐enhanced ultrasound, high‐frequency ultrasound, and ultrasound elastography, has dramatically expanded the options available to the neurosurgeon intraoperatively. But the intraoperative ultrasound has essential disadvantages and limitations in practical application such as:
- large craniotomy hole for ultrasound probes;
- special positioning system with sensors on the ultrasound probe for superposition MR or CT and ultrasound imaging;
- cerebrospinal fluid (CSF) drainage; -
- artefacts of ultrasound imaging especially on the saline/brain tissue barrier
- very high operator variability.
One of directions in the development of ultrasound technologies for neurosurgery to exclude the limitations of intraoperative ultrasound.
Transcranial ultrasound navigation could provide minimally invasive neurosurgery navigation and real time monitoring of manipulator affecting.
However transcranial ultrasound imaging are of poor quality in traditional ultrasound systems. This is because of the aberration owing to cranial bone through which brain investigation is performed.
The new technology of transcranial ultrasound imaging with good image quality for navigation in brain neurosurgery was developed in company PKF “IZOMED”, Moscow.
Project is focused on the significant improvement of quality and information content of diagnostic ultrasound transcranial brain imaging systems. The method implies the use of specific adjusting procedure, which allows an evaluation and further compensation of brain tissue-mediated distortion due to scull bone. Pilot experiments have indicated a possibility of evaluation of such distortion and verified method feasibility.
On the basis of the method effectiveness evaluation and pilot experiments it may be concluded that the new method will be extensively used in medical practice.
The current state of research in the given field. The main effort of foreign and Russian researchers is put towards the theoretical and experimental studies in order to develop the directed therapeutic ultrasound systems for transcranial brain focusing (HIFU). There is no information available on the finished transcranial ultrasound brain imaging quality improvement studies.
The expected result of the project realization, a new technology that is expected to could provide minimally invasive neurosurgery navigation and real time monitoring of manipulator affecting will be widely implemented in medical practice.
The possibility and ways of commercialization of the project findings. After the R&D is complete, the full-scale production of ultrasonic diagnostic equipment of the new class with the non-conventional diagnostic features will be started.
Market prospects. The suggested method has no equivalents, therefore the market of the ultrasonic navigation systems based on the new technology will be perspective.