Editors
Karanjit Singh
Narang
Associate Director (Neurosurgery) Institute of Neurosciences Medanta—The Medicity
Gurugram,
Haryana,
India
Ajaya Nand
Jha
Chairman Institute of Neurosciences Medanta—The Medicity
Gurugram,
Haryana,
India
Foreword
Michael Schulder
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Intraoperative Imaging in Neurosurgery
First Edition: 2017
9789386322906
fm5Dedicated to
My loving wife Dr Sherry Narang, my kids Gurneet and Harjas and my caring parents.
Over and above to all my patients whohave taught me and are still teaching me.
—Karanjit Singh Narang
Everyone who has made my life more worthwhile. My wife Dr Urvashi Prasad Jha, who is my greatest motivator; my children Ruchira and Siddharth Jha; son-in-law and daughter-in-law, Dr Ashu Jadhav and Trudy Rebert, and of course, my mother, Mrs Sita Jha.
fm7Contributors
- Aditya Gupta
- Director Neurosurgery
- Artemis Hospital
- Gurugram, Haryana, India
- Ajaya Nand Jha
- Chairman
- Institute of Neurosciences
- Medanta—The Medicity
- Gurugram, Haryana, India
- Alessandro Olivi
- Direttore
- Instiute id Neurochirurgia Resposabile
- UOC di Neurochirurgia
- Largo Gemelli 8, Roma
- Alexandra J Golby
- Director
- Image-guided Neurosurgery
- Professor (Neurosurgery)
- Harvard Medical School
- Brigham Health and Women's Hospital
- 75, Francis Street
- Boston, MA 02115
- Massachusetts, USA
- Ami Raval
- Senior Neurosurgery Specialist
- Boston, MA, Massachusetts, USA
- Health Care Associates in Medicine, PC
- 1099 Tagree Street
- Staten Island, NY 10304
- New York, USA
- Andreas Unterberg
- Professor, Director and Head
- Department of Neurosurgery
- Heidelberg University Hospital
- Im Neuenheimer Feld 400 69120
- Heidelberg, Germany
- Anshu Mahajan
- Associate Consultant Neurointerventional Surgery
- Medanta—The Medicity
- Gurugram, Haryana, India
- Christian Senft
- Professor and Vice Chairman
- Center of Clinical Neurosciences
- Department of Neurosurgery
- University Hospital Frankfurt
- Frankfurt, Germany
- Christopher Nimsky
- Professor and Chairman
- Department of Neurosurgery
- The Philipps University of Marburg
- Baldingerstrasse
- 35033 Marburg, Germany
- Deepak Bhangale
- Associate Consultant Neurosurgery
- Medanta—The Medicity
- Institute of Neurosciences
- Gurugram, Haryana, India
- Gavin Quigley
- Consultant Neurosurgeon
- Royal Victoria Hospital
- Belfast BT12 6BA, UK
- Gord Von Campe
- Head Neurosurgery
- Department of Neurosurgery
- Medical University of Graz
- Auenbruggerplatz 29
- A-8036 Graz, Austria
- Harsh Sapra
- Director Neuroanesthesia
- Medanta—The Medicity
- Gurugram, Haryana, India
- Senior Neurosurgeon
- Fellow of the Royal College of Surgeons, Edinburgh
- Fellow of Academy of Medicine (Neurosurgery), Singapore
- Practices at Neurosurgery Partners, Brain + Spine Solutions
- 38 Irrawaddy Road, #10–60/62
- Mount Elizabeth Novena Specialist Center
- Singapore 329563
- Karanjit Singh Narang
- Associate Director Neurosurgery
- Institute of Neurosciences
- Medanta—The Medicity
- Gurugram, Haryana, India
- Michael R Chicoine
- Associate Professor
- Department of Neurosurgery
- Washington University School of Medicine
- 660 S Euclid Avenue, Campus Box 8057
- St Louis, Missouri 63110, USA
- Michael Schulder
- Professor and Vice Chairman
- Residency Program Director
- Director, Brain Tumor Center
- Department of Neurosurgery
- Hofstra Northwell School of Medicine
- Hofstra University
- 450, Lakeville Road
- Lake Success, NY 11042, New York, USA
- Vice President, World Society for
- Stereotactic and Functional Neurosurgery
- AANS Historian
- Moritz Scherer MD
- Resident of Neurosurgery and Research Fellow
- Heidelberg University Hospital
- Im Neuenheimer Feld 400
- 69120 Heidelberg, Germany
- Olutayo Olubiyi
- Post-doctoral Research Fellow
- Golby Lab Research Fund and
- Neurosurgical Brain Mapping Lab
- Department of Neurosurgery
- Harvard Medical School
- Boston, MA 02115, Massachusetts, USA
- Pawan Goyal
- Consultant Neurosurgery
- Artemis Hospital
- Gurugram, Haryana, India
- Peter Nakaji
- Senior Neurosurgeon
- Barrow Neurological Institute
- St John's Hospital and Medical Center
- 2910 North Third Avenue
- Phoenix, Arizona AZ 85013, USA
- Ratnadip Bose
- Associate Consultant Neurosurgery
- Institute of Neurosciences
- Medanta—The Medicity
- Gurugram, Haryana, India
- Richard Bucholz
- Co-President of IOIS
- St Louis University
- St Louis, Missouri, USA
- Rishabh Kedia
- Associate Consultant Neurosurgery
- Medanta—The Medicity
- Institute of Neurosciences
- Gurugram, Haryana, India
- Roy Torcuator
- Senior Neurosurgeon and Neuro-oncologist
- St Luke's Medical Center
- 32nd Street, Fort Bonifacio, Taguig
- Manila, Philippines
- Sudhir Dubey
- Director Neurosurgery
- Institute of Neurosciences
- Medanta—The Medicity
- Gurugram, Haryana, India
- Vipul Gupta
- Director Neurointerventional Surgery
- Artemis Hospital
- Gurugram, Haryana, India
Intraoperative Imaging in Neurosurgery is testimony to the rapid pace of change in our world. When I presented preliminary work on the use of a low-field compact intraoperative MRI (iMRI) at the 2000 meeting of the Neurological Society of India (NSI), there were a handful of iMRI units around the world. This was a time of great excitement for us, where our idea of best and most detailed imaging method could be actually incorporated into our operating rooms. The general reaction at the NSI conference was that such luxuries were very nice in the United States or Western Europe, but Indian neurosurgeons would have to make do with much simpler technology at best, may be two-dimensional ultrasound.
How times have changed, for better and for worse. Many Indian neurosurgical centers now use the most sophisticated devices for intraoperative imaging, including iMRI, intraoperative computed tomography, and three-dimensional intraoperative ultrasonography. These have been joined in this work by neurosurgeons elsewhere in Asia and of course around the world. Many institutions have contributed peer-reviewed publications that demonstrate the utility of iMRI and meet the criteria for evidence-based medicine. Intraoperative imaging has been embraced by colleagues around the world.
On the other hand, this complex and expensive technology has been challenged as not being “cost-effective”. Many neurosurgeons reject the extra time and work involved in imaging during surgery. Industrial partners have lost interest as hospital systems shy away from the necessary investment for iMRI implementation. About 45 years ago, the United States made trips to the moon and back routine. Now that expertise has been lost, because of a lack of political will and a collective insistence that we build on the early accomplishments of the Apollo astronauts. Will neurosurgery see the same thing happen with iMRI? Do we lack the political will to insist that we make intraoperative imaging a ubiquitous technology, another step forward in taking the guesswork out of brain surgery of all kinds?
I hope that the book will spur us to continue our efforts to ensure that we keep pushing forward with the development of iMRI and related technologies, so that they become as expected a part of neurosurgical routine as has been the case for diagnostic MRI and surgical navigation. Let us go forward and not backwards.
Michael Schulder MD
Professor and Vice Chairman
Residency Program Director
Director, Brain Tumor Center
Department of Neurosurgery
Hofstra Northwell School of Medicine
Hofstra University
450, Lakeville Road
Lake Success, NY 11042, New York, USA
Vice President, World Society for
Stereotactic and Functional Neurosurgery
AANS Historian
fm11Preface
Our first exposure to neurosurgery during general surgery residency left us with an impression of unconscious patients with shaved heads, and the neurosurgeon drilling burr holes manually with Hudson's brace hoping to hit the spot, having blood under the bone. As general surgery residents, we never understood why they cannot do an exploratory craniotomy such as we used to exploratory laparotomy and look inside. The answer from the Chief of Neurosurgery was a bit snobbish, but very true—neurosurgery requires pin-point precision. We cannot sacrifice a millimeter of brain, unlike people who can get away by removing feet of intestines.
After entering neurosurgical residency, we fully understood the need for precision. From marking the skin incision to reaching the intraparenchymal pathology accurately in neurosurgery, required experience, training and a lot of luck. Post- operative scans would show residual tumor and re-exploration was not uncommon. Things changed when navigation was adopted. Accuracy in marking scalp incisions and reaching target pathology increased significantly.
Only after we started working in an institute with intraoperative MRI, did we realize what we were leaving behind after surgery. It was like a Lie Detector test. You do the surgery, and then think it was a good job done until the MRI picks up the fallacy!
Our strong motivation to compile the book was to spread awareness and education regarding the available technology today, that can help in making neurosurgery more safe and precise.
The book has valuable contributions from authors from all over the world who share their experiences with the specific technologies, they use for intraoperative imaging.
Karanjit Singh Narang
fm13Acknowledgments
We sincerely thank:
- All our contributors for taking time out from their hectic schedules, to provide their chapters.
- Our families for putting up with us through all these years.
- Our colleagues for their persistent efforts to ensure completion of this book, especially Drs Rishabh Kedia and Ratnadip Bose and Ms Marion Gomes.
- Our long suffering publisher, M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India.
- Most of all, our patients.