ISRACAS'2000 -- Invited Presentation

Evolution and Future of Computer-assisted Neurosurgery

Prof. Gene H. Barnett, MD

Vice-Chairman

Department of Neurological Surgery

The Cleveland Clinic Foundation

Cleveland, OH, USA

 

The roots of computer-assisted neurosurgery reside in frame stereotaxy – a technology that almost became extinct with the development of medical treatment for functional disorders in the 1960s. A renaissance of stereotactic techniques emerged in the late 1970s when it became possible to extract spatial information from CT scans that could be used to direct a stereotactic apparatus. More imaging modalities such as MRI and angiography became applicable and a broad array of diagnostic and interventional procedures were developed or refined using computer image guidance such a biopsy, minimal access craniotomy, depth electrodes, third ventriculostomy and radiosurgery. The transition from point to volumetric stereotaxy allowed for the surgical techniques to be developed that would prove necessary to best use the next revolution in computer-assisted neurosurgery – the surgical navigation system. The availability of accurate 3-dimensional digitizers, fast imaging computers and spatially accurate imaging came together in the mid 1980s and led to these systems that provide real-time localization, orientation and guidance using preoperative imaging. Today, these systems have emerged as the standard of care for many neurosurgical procedures, both in the head and spine. Today, development focuses on methodology to provide intraoperative updates of imaging information for these navigation systems, and to use them to control effectors (i.e., robots). As these platforms become more robust they will evolve into surgical information systems. They will collect, hold and correlate myriad forms of relevant patient information and serve as a “smart” conduit to information any where that the internet allows.