Mjerenje točnosti i pouzdanosti neurokirurških stereotaktičnih uređaja

master's thesis

• Title (english): Precision and reliability assessment of neurosurgical stereotactic devices
• Author: Stjepan Šurbek
• Mentor: Darko Chudy (mentor)
• Committee member: Fran Borovečki (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Darko Chudy (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Stereotaktični neurokirurški zahvati podrazumijevaju postavljanje pacijentove glave u Kartezijev trodimenzionalni koordinatni sustav pomoću modernih trodimenzionalnih slikovnih pretraga. Tako se može precizno odrediti lokacija regije interesa u mozgu te optimalna putanja ili trajektorij neurokirurškog instrumenta do nje. Prvi službeni opis takvog pristupa potječe s početka dvadesetog stoljeća kada su dva znanstvenika, Horseley i Clarke, prvi puta upotrijebili stereotaktični okvir na majmunima. Postoje različite vrste stereotaktičnih uređaja. Konvencionalna stereotaksija podrazumijeva pričvršćivanje stereotaktičnog okvira na pacijentovu glavu dok neki noviji uređaji omogućuju tzv. „bezokvirnu stereotaksiju“ (engl. frameless stereotaxy). Kod konvencionalne stereotaksije za pacijentovu lubanju se pričvrsti okvir tako da je odnos pacijentove glave i okvira stalan. Tako se snimanjem slikovnim metodama svakoj točki unutar pacijentove lubanje mogu odrediti koordinate u odnosu na okvir. Prilikom operacije držač instrumenta se postavlja na okvir prema točno izračunatim koordinatama ciljne lokacije te trajektorija. Takav pristup omogućuje točno planiranje operacije prije same incizije kože uz minimalnu invazivnost. Najvažnije indikacije za stereotaksiju su stereotaktična biopsija te duboka mozgovna stimulacija. Strukture koje se ciljaju stereotaksijski su vrlo sitne. Također, prilikom operacije kirurg ne može direktno vizualizirati položaj instrumenta već pogađa unaprijed određene koordinate u pacijentovu mozgu. Zato je jako važno da svaki neurokirug koji koristi stereotaksiju bude upoznat s točnošću i pouzdanošću uređaja koji koristi, odnosno da razumije koliko će koordinate zadane strukture i trajektorij isplaniran i izračunat kompjutorski pomoću slikovne dijagnostike odgovarati stvarnim položajima pri samoj operaciji. Sumarna klinički relevantna pogreška stereotaktičnog zahvata ovisi o pogreškama u svakom proceduralnom koraku uključujući snimanje, odabira cilja (regije od interesa), uračunavanje trajektorija i mehaničke greške samog stereotaktičnog okvira.

Abstract (english)

Stereotactic neurosurgical procedures pertain to using a three-dimensional imaging diagnostic tool to accurately define a three-dimensional Cartesian coordinate system of the patient's head. By these methods, one can precisely determine the location of the brain region of interest and plan the optimal surgical instrument pathway or trajectory to it. These kind of
procedures date back to the beginning of the twentieth century when two scientists, Horseley and Clarke, first used a stereotactic device on monkeys. There are various kinds of stereotactic devices. Conventional stereotaxy pertains to fixating a stereotactic frame to the patient's head. Newer technologies have made it possible to perform a stereotactic procedure without a frame, so-called frameless stereotaxy. The frame is fixated to the patient's skull in such a way so that the relation of the frame to the head is constant. By doing an imaging scan one can precisely determine the coordinates of every intracranial point with reference to the frame. During the surgical procedure the instrument holder is attached to the frame according to the coordinates of the target brain region of interest and trajectory. Such an approach enables a minimally invasive surgical procedure that had been precisely planned before it even started. The most relevant indications include stereotactic biopsy and deep brain stimulation. The structures of interest are very tiny. Furthermore, during the procedure the surgeon does not directly visualize the location of the instrument, they aim for the set coordinates. Hence, it is very important for a neurosurgeon, when using a stereotactic device for a certain procedure, to be fully aware of its precision and reliability which means to understand to what extent do the target coordinates and the planned trajectory correspond to the actual target location and instrument pathway during the procedure. The total clinically relevant error comprises errors associated with each procedural step, including imaging, target selection, trajectory calculations, and the mechanical errors of stereotactic frames.

• Keywords: neurokirugija; stereotaksija; točnost; pouzdanost
• Keywords (english): neurosurgery; stereotaxy; precision; reliability
• Language: croatian
• URN:NBN: urn:nbn:hr:105:709939
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-03-14 10:40:20