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  • 1
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Nuclear Instruments and Methods in Physics Research Section A: 288 (1990), S. 227-235 
    ISSN: 0168-9002
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Physics
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-2102
    Keywords: Key words Intraoperative • MRI • Brain tumor • Extend of resection • Image guided surgery ; Schlüsselwörter Intraoperativ • MRT • Hirntumor • Operationsradikalität • Neuronavigation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Auch für erfahrene Neurochirurgen ist es außerordentlich schwierig bis unmöglich, intraoperativ die Grenze eines hirneigenen Tumors zu erkennen und entsprechend dieser Grenze eine „Totalentfernung“ des Tumors durchzuführen. Verschiedene Studien zeigten die Unzuverlässigkeit der intraoperativen Einschätzung der Operationsradikalität. Während intraoperative CT-Kontrollen und intraoperative Ultraschallkontrollen bereits seit längerem eingesetzt werden, wurde der Magnetresonanztomographie – der bildgebenden Methode mit der höchsten Weichteilauflösung – dieser Anwendungsbereich erst kürzlich durch die Entwicklung „offener“ MR-Systeme erschlossen. Im Operationstrakt der neurochirurgischen Klinik der Universität Heidelberg wurde ein offener MR-Tomograph installiert, an dem neben Biopsieentnahmen und neurochirurgischen Interventionen auch intraoperative MR-Kontrollen der Operationsradikalität durchgeführt werden. Unsere ersten Erfahrungen deuten darauf hin, daß durch den Einsatz intraoperativer MRT die Operationsradikalität neurochirurgischer Eingriffe gesteigert werden kann. Allerdings war bei allen Patienten durch die chirurgische Manipulation selbst verursachtes Kontrastmittelenhancement nachweisbar, das z. T. Verwechslungspotential mit Resttumor besaß.
    Notes: Purpose: The main aim of our study was to find out whether the combined use of neuronavigation and intraoperative MRI can increase the rate of “complete tumor removal”. The second aim was to characterize the different forms of surgically induced enhancement in order to differentiate them from residual tumor. Materials and methods: Surgery was performed in 18 patients with high-grade glioma. Using a neuronavigation device, the surgeons operated up to the point where they would otherwise have terminated surgery. Intraoperative MRI was then performed to determine whether residual enhancing had been left behind and to update the neuronavigation device. If necessary, feasible surgery was continued. On days 1–3 after surgery early postoperative MRI (1.5 T) was performed. The proportion of patients in whom the enhancing tumor was completely removed was compared with a series of 60 patients with glioblastoma multiforme, who had been operated on using neither neuronavigation nor intraoperative MRI . We also looked for and characterized different types of surgically induced enhancement. Results: Intraoperative MRI definitely showed residual tumor in 6 of the 18 patients and resulted in ambiguous findings in 3 patients. In 7 patients surgery was continued. Early postoperative MRI showed residual tumor in 3 patients and resulted in uncertain findings in 2 patients. The rate of patients in whom complete removal of enhancing tumor could be achieved was 50 % at the time of the intraoperative MR examination and 72 % at the time of the early postoperative MR control. The difference in proportion of patients with “complete tumor removal” between the groups who had been operated on using neuronavigation (NN) and intraoperative MRI (ioMRI) and those who had been operated on using only modern neurosurgical techniques except NN and ioMRI was statistically highly significant (Fisher exact test; P = 0.008). Four different types of surgically induced contrast enhancement were observed. These phenomena carry different confounding potentials with residual tumor. Conclusion: Our preliminary experience with intraoperative MRI in patients with enhancing intraaxial tumors is encouraging. Combined use of neuronavigation and intraoperative MRI was able to increase the proportion of patients in whom complete removal of the enhancing parts of the tumor was achieved. Surgically induced enhancement requires careful analysis of the intraoperative MRI in order not to confuse it with residual tumor.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Der Radiologe 40 (2000), S. 211-217 
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Computerassistierte Neurochirurgie ; Computerintegrierte Neurochirurgie ; Neuronavigation ; Robotik ; Telemedizin ; Telechirurgie ; Virtuelle Realität ; Key words Computer-assisted neurosurgery ; Computer-integrated neurosurgery ; Neuronavigation ; Robotics ; Telemedicine ; Telesurgery ; Virtual reality
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Definition: Virtual reality enables users to immerse themselves in a virtual three-dimensional world and to interact in this world. The simulation is different from the kind in computer games, in which the viewer is active but acts in a nonrealistic world, or on the TV screen, where we are passively driven in an active world. In virtual reality elements look realistic, they change their characteristics and have almost real-world unpredictability. Use of virtual reality: Virtual reality is not only implemented in gambling dens and the entertainment industry but also in manufacturing processes (cars, furniture etc.), military applications and medicine. Especially the last two areas are strongly correlated, because telemedicine or telesurgery was originated for military reasons to operate on war victims from a secure distance or to perform surgery on astronauts in an orbiting space station. In medicine and especially neurosurgery virtual-reality methods are used for education, surgical planning and simulation on a virtual patient.
    Notes: Zusammenfassung Definition: Virtuelle Realität (VR) erlaubt dem Benutzer, in eine dreidimensionale Welt einzutauchen (engl.: to immerse, daher immersive VR) und in dieser virtuellen Welt zu agieren. Damit unterscheidet sich die VR von den bekannten Vorstellungen, z.B. in Computerspielen, wo man aktiv in einer irrealen Welt agiert, oder in Spielfilmen, wo man passiv an einer realen Welt teilnimmt. In der virtuellen Realität agiert man aktiv in einer Welt mit realistisch erscheinenden Elementen, die ihr Erscheinungsbild ändern können und daher „weitgehend unberechenbar” sind. Anwendung: Virtuelle Realität hat den Einzug nicht nur in Spielhallen und die Unterhaltungsindustrie gefunden, sondern auch in industrielle Fertigungsanlagen (Autos, Möbel usw.), militärische Bereiche und die Medizin. Gerade die beiden letzten Bereiche sind eng verknüpft, denn mit dem Begriff Telemedizin verband sich ursprünglich die Idee, im Kriegsfall Operationen an verwundeten Soldaten mit ferngesteuerten Robotern aus sicherem Abstand heraus durchzuführen oder Astronauten von der Erde aus zu behandeln. In der Medizin, speziell in der Neurochirurgie, werden heute bereits virtuelle Methoden zu Ausbildungszwecken, zur Operationsplanung und zu Operationen am virtuellen Patienten eingesetzt.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1572-9672
    Source: Springer Online Journal Archives 1860-2000
    Topics: Physics
    Notes: Abstract Repeated observations of LMC X-4 with EXOSAT were carried out in 1983/84 in order to study its 30.5 day cycle and to cover the expected outbursts of the recurrent LMC transient A0538-66. The latter source was inactive during our campaign although a variable circumstellar envelope was still present around the optical counterpart. At least ten further X-ray sources are detected in the CMA field of view around LMC X-4 including the SNR N49 which is the possible site for the March 5, 1979 γ-ray burster and N63A which appears to be variable in X-ray luminosity. We furthermore discuss the strongest sources that were not present in a previous EINSTEIN survey of the LMC.
    Type of Medium: Electronic Resource
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