Electromagnetic neuronavigation in neuroendoscopy. Navigation proposal for the LOTTA ventriculoscope. Technical note.

Mario Gomar-Alba, José Javier Guil-Ibáñez, Fernando García-Pérez, María José Castelló-Ruíz, Leandro Saucedo, Antonio José Vargas-López, José Masegosa-González
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Abstract

Background and objective: Neuronavigation in ventriculoscopy has been described in several papers. However, there are different ventriculoscopes and navigation systems. Because of these different combinations, it is difficult to find detailed navigation protocols for each ventriculoscope. We describe, step by step, a simple method to navigate both the trajectory to reach the ventricular system and the intraventricular work for the LOTTA ventriculoscope.

Methods: We used a rigid ventriculoscope (LOTTA, KarlStorz) with an electromagnetic stylet (S8-StealthSystem, Medtronic) as the main navigation tool. The protocol is based on a 3D printed trocar or alternatively, on a modification of the original trocar for extraventricular phase navigation and a modified pediatric nasogastric tube for intraventricular phase navigation.

Results: The protocol can be set up in less than 10min. The extraventricular part is navigated by inserting the electromagnetic stylet inside the 3D printed trocar or inside the original modified trocar. Intraventricular navigation is performed by combining a modified pediatric nasogastric tube with the electromagnetic stylet inside the working channel of the endoscope. The most critical point is to obtain a blunt, bloodless approach to the ventricle and to achieve perfect alignment of all target structures by means of previously planned pure straight trajectories.

Conclusions: This protocol is easy to set up, avoids rigid head fixation, bulky optical navigation accessories, while allows continuous navigation of both parts of the surgery. Since we have implemented this protocol, we have seen a significant improvement in both simple and complex neuroendoscopy procedures as the surgery is dramatically simplified.

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神经内镜中的电磁神经导航。LOTTA 脑室镜导航建议。技术说明。
背景和目的:多篇论文对脑室镜检查中的神经导航进行了描述。然而,脑室镜和导航系统各不相同。由于这些不同的组合,很难找到适合每种脑室镜的详细导航方案。我们将逐步描述一种简单的方法,为 LOTTA 心室镜导航到达心室系统的轨迹和心室内工作:方法:我们使用带有电磁针(S8-StealthSystem,美敦力)的刚性心室镜(LOTTA,KarlStorz)作为主要导航工具。该方案基于三维打印套管,或者对原始套管进行改装,用于室外期导航,对改装后的小儿鼻胃管用于室内期导航:结果:该方案可在 10 分钟内完成设置。结果:该方案可在 10 分钟内完成设置,通过在 3D 打印套管内或原始改良套管内插入电磁针来导航室外部分。在内窥镜的工作通道内,通过将改良的小儿鼻胃管与电磁套管相结合来进行腔内导航。最关键的一点是钝性、无血地进入心室,并通过先前规划的纯直线轨迹实现所有目标结构的完美对准:该方案易于设置,避免了僵硬的头部固定和笨重的光学导航配件,同时允许对手术的两个部分进行连续导航。自从我们实施这一方案以来,简单和复杂的神经内镜手术都有了显著改善,因为手术大大简化了。
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