Neurosurgery Residency Program

The digital universe is expanding. In healthcare it’s expanding even faster than in other sectors. Hospitals typically spend large amounts of money to generate data – in particular image data – but spend much less to process and enhance the resulting information so it can be efficiently used beyond radiology. One of the most challenging places in a hospital, where managing a variety of complex data may even become a matter of life or death, is the operating room. This is why Brainlab, for more than 25 years, has been focusing its efforts on making data in the operating room more clinically relevant and accessible.

Brainlab helps surgeons to get the most out of available image and patient data. By not pursuing a “closed ecosystem” strategy but rather offering open platforms, we strive for more seamless integration of data generated by devices of leading instrument, imaging and implant providers.

Four key areas hold the potential to change clinical routines:

  • Empowering INSIGHTS AND PLANNING: Brainlab Elements Software
  • Augmented NAVIGATION: Brainlab Microscope Navigation
  • Intelligent ASSISTANCE: Brainlab Robotics
  • Intraoperative IMAGING: Airo Mobile Intraoperative CT
Elements Software

ELEMENTS1

Brainlab Elements are efficient, effective, à la carte software modules serving multiple clinical specialties, including interactive and automatic segmentation applications for state-of-the-art planning of image guided surgery.

Elements Viewer 3D provides streamlined access to patient datasets, fundamentally informing every planning and decision-making process with quick and direct interaction with DICOM images.

Elements Smartbrush is intelligent computer-assisted tumor outlining that deeply expands target definition, incorporating multiple modalities and exploiting multi-planar volume definition.

Elements Segmentation Cranial uses a patented Synthetic Tissue Model for fully automated anatomical segmentation that flexibly adapts to various anatomies and modalities, defining anatomical structures with high consistency and accuracy.

Elements Trajectory Planning features preconfigured view modes for definition and verification of neurosurgical approaches, compiling all relevant data, such as target structure, segmentations and fibertracks, in one place.

Elements Image Fusion brings the plan together. Fully automated dataset correlation provides flexibility to contour on any dataset.

Elements Distortion Correction creates datasets with more accurate (deformed) co-registrations enabling high-precision contouring and Fibertracking across modalities.

Elements Fibertracking easily enriches anatomical images with detailed information about eloquent white matter structures to preserve vital functions with unique methods such as dynamic live tracking on the Brain Projection view.

Elements Adaptive Hybrid Surgery Analysis provides neurosurgeons with clear previews of adjuvant radiosurgery in benign skull base tumor cases.

Elements TRAMs2 differentiates between contrast clearance and accumulation and supports clinicians in separating tumor progression and treatment effects, such as radiation necrosis.

Microscope Navigation

MICROSCOPE NAVIGATION3

The way surgical microscopes are used is in transition: Combined with the new robotic capabilities of microscopes, as well as the use of exoscopes, navigation now plays an indispensable role in performing state-of-the-art surgeries. Brainlab accommodates neurosurgeons’ needs in both the traditional approach of looking through the ocular as well as the more recent utilization of exoscope video images displayed on a dedicated screen.

Reflective markers attached to the microscope enable visual tracking of optical axis and focal point. Microscope Navigation visualizes the planned surgical target and surrounding structures as semi-transparent volumes mixed with the anatomy seen, providing better spatial orientation throughout the procedure. Touch-based rotation of the displayed 2D video image or Probe’s Eye reconstruction reveals underlying structures in 3D for more anatomical insight.

Microscope Navigation not only displays relevant information on the navigation screen, but also injects this data directly into the ocular, providing surgeons meaningful context without distracting from the surgical situation.

In order to maintain navigation accuracy, especially after craniotomy, anatomy shift can be visualized by comparing vessels on the cortex with their corresponding MIP (maximum intensity projection). Patient registration is then updated through touch-based matching of vessels and MIP on the navigation screen.

Using the microscope should always be ergonomic, efficient and ideally hands-free. Microscope Navigation supports the robotic alignment to any navigated instrument. With the microscope moving autonomously – starting at any position until it reaches its new position with center and focus on the navigated tool – surgeons no longer need to re-align the microscope by hand.

Airo® Mobile Intraoperative

AIRO® MOBILE INTRAOPERATIVE CT

Airo is ideal for cranial, spine and trauma procedures and designed to function inside existing O.R. suites. High CT image quality increases surgeon confidence and supports advanced minimally invasive surgery.

Airo provides full Hounsfield soft tissue imaging that offers better definition of the spine. The scan volume of D 51.2 x 100cm allows surgeons to image the entire spine in a single scan and to visualize more anatomical context than 3D C-arms.

Innovative design intelligently combines the largest gantry opening on the market with a slim gantry and small footprint. The gantry houses custom components including an X-Ray tube, 32-slice helical scan detector array, high-voltage generator, air cooling system and built-in battery pack.

Total integration of the O.R. table offers fixed correlation between patient and scanner resulting in reproducible imaging. Fully adaptable, Airo moves into a variety of procedural setups for cranial, spine and trauma cases. The extra-large gantry opening expands intraoperative surgical value and even accommodates spinal positioning frames.

The compact Airo system pendant controls everything. During procedures, surgeons and staff program imaging with laser alignment and dose display from the detachable and user-friendly Airo touch screen. Movement and maintenance are also swift and steady with the Airo handheld system controller responsible for transport, daily calibration and system maintenance.

Robotics

ROBOTICS4

Robotics in neurosurgery is gaining momentum. The Brainlab robotic product for spinal and cranial applications – partnered with medineering – will be unique due to its modularity, combining a mechatronic arm with a variety of attachments and intuitive software guidance. Seven degrees of freedom enable a wide range of movements. A human arm design supports intuitive system use and facilitates efficient draping.

While navigation provides effective support in reaching surgical targets, the arm system further simplifies alignment procedures and therefore perfectly complements navigation technology. A unique side rail attachment and fully integrated computer unit save valuable footprint in the O.R. The quick booting time ensures the device is ready to use in seconds.

Different arm attachments, like a passive drill guide or the robotic alignment module, can be easily mounted to the mechatronic arm interface. This modular concept becomes an extension of spinal and cranial applications. In procedures using Airo for intraoperative imaging, the arm system can remain attached during the scan.

The new “Arm Alignment” software runs in parallel and communicates with the navigation software. Both can be displayed side-by-side on dual monitor systems. The alignment software indicates the arm’s configuration, position and distance to target. Visual guidance leads the surgeon to the closest trajectory. Target position memory guides the surgeon back to a previously stored position.
After alignment, the fixed arm position enables stable holding and reproducible insertion of multiple instruments. In spinal drilling procedures, the mechatronic arm assists the surgeon by keeping inserts constantly in place throughout the procedure. This allows the surgeon to focus on screw or K-wire placement using one of the compatible Brainlab tubes.

1

Products are available or a work in progress

2

FDA clearance pending

3

FDA clearance pending (for new features)

4

Commercial availability pending