Webinar- Utilizing the exoscope in neurosurgical oncology

Utilizing the exoscope in neurosurgical oncology

Explained by Dr. Nader Sanai

see Video here

The following time-stamps will guide you to certain key points & examples during this webinar:

At 1:30: “Moving from a pure optical platform to a digital platform is something that we are going to see increasingly in our operating rooms”

At 3:10: “As a tumor surgeon, we have multiple information chains, we have the structural MRI, functional MRI, tractography, MR spectroscopy, MAG imaging, fluorescence-guided surgery, intraoperative navigation and all of these things have to be integrated in our brains and extrapolated through our actions with the tumor. I think what this platform (ZEISS KINEVO 900) is enabling us to do, is give us the ability to integrate a lot of this in real-time so that we do not have to do this ourselves and we do not have to be swiveling our heads to look at this scan or that scan as we are operating.”

At 6:01: “Now, the PointLock concept is really one where you want to specifically focus on a particular target in three-dimensional space. But you want to be able to pivot around it without having to find it again. We all do that in the OR and while it may take only few seconds, those are precious seconds where you lose your chain of thoughts. [..] Achieving this at a functional level… and by that I mean the ability where the robot does it for you and you do not have to adjust at all in terms of fine tuning the focus or fine tuning the special referencing [..] I have used it in the OR, really without any training on it and it is something very intuitive.”

At 7:17: “Many of us use MRI spectroscopy (for example) to identify hotspots where we will perform biopsy. For example, in a low grade tumor we want to decrease the chance of missing a focus of transformation. By bookmarking those sites on the microscope, we can make sure that we can go directly to that spot without worrying about aligning the navigation and all of the other anatomical information around it.”

At 9:06: “In brain tumor operations there are many dimensions of the tumor that we need to work along and we often operate – move the microscope – operate. This platform enables you to continuously operate as you are moving. And, if you are using it as an exoscope function (particularly), you, yourself don’t have to move at all. Effectively, the microscope moves and you stay still. [..] it is an important distinction when you are doing a multi-hour operation and you are able to stay in a position of comfort and stability [..] instead of moving around your torso to accommodate the dimension.”

At 11:03: “The next generation of microscope will be something that is not so much part of you but is working in parallel with you. [..] For example, in a far-lateral type approach for lower cranial schwannoma, there are issues in positioning and the angle of view. But here we can operate in a relatively neutral position using 3D 4K visualization.“

At 13:13: Case explanation for Retrosigmoid Crainiotomy for Petrous Face Meningioma using the combination of exoscopic visualization and robotics.

At 13:54: “This is at the point where one can transition to the exoscope. Because the angles of approach that you want as you are trying to pull this tumor away from the brain tumor margins, really can be quite extreme. You can see in the inset where the angle of the microscope head is relative to my head. If I had to stretch to get to that angle I’m going to be relatively uncomfortable and less stable ergonomically with my hands and torso.”

At 15:12: “I would also add that the learning curve for this is not very steep. It is a relatively simple device to adopt into your workflow because many of us have already gotten used to using the foot pedal for basic robotic movements of the microscope head. What this does is: add these additional dimensions of moving in an angle and pivoting around a point. So, it is really like a real-time surveillance image happening as you operate.

At 16.31: “The digital integration of real-time functional imaging, real-time tractography, real-time stimulation mapping data into the cortex will basically make it seamless.”

Register Today for This Free Webinar: Strategic Use of BCNU Wafers in Contemporary Care

Register Today for This Free Webinar: Strategic Use
of BCNU Wafers in Contemporary Care

Aug. 23, 2017, at 7 p.m. EDT
Aug. 30, 2017, at 6 p.m. PDT

Register Now >

Faculty
Lynn Stuart Ashby, MD
Assistant Director, Neuro Oncology Program
Barrow Neurological Institute (BNI)
Phoenix, AZ
Eyas M. Hattab, MD, MBA
AJ Miller Professor and Chair
Pathology and Laboratory Medicine
Louisville, KY
Timothy C. Ryken, MD, MS, FACS, FAANS
Professor and Chief
Section of Neurosurgery
Dartmouth-Hitchcock Medical Center
Lebanon, NH
In this one-hour webinar, participants will receive an overview on the practical use of BCNU Wafers for the treatment of newly diagnosed high-grade malignant glioma as an adjunct to surgery and radiation and recurrent glioblastoma multiforme as an adjunct to surgery. Neurooncology, neuropathology and neurosurgery perspectives will be presented in the discussion covering peri-operative considerations for BCNU Wafer implantation as part of a multimodal treatment plan.
Learning Objectives

  • Review historical changes in incidence and survival over recent decades for high grade malignant glioma (HGG) and summarize current FDA approved treatments.
  • Evaluate pivotal evidence for the use of BCNU wafers and indications for newly diagnosed and recurrent HGG setting.
  • Develop strategic approach for integrating BCNU wafers into multimodal standard treatment for patients at diagnosis and relapse of HGG.
  • Discuss prerequisites for successful intraoperative consultation (IOC) outcomes and overcoming challenges in surgical neuropathology.
  • Learn how to bridge the intraoperative gap between pathology and neurosurgery.
  • Identify the best operative and post-operative approaches toward optimizing outcomes following BCNU wafer implantation.

IMPORTANT SAFETY INFORMATION
GLIADEL Wafer can cause fetal harm when administered to a pregnant woman. It is recommended that patients receiving GLIADEL Wafer discontinue nursing. Female patients of reproductive potential should receive counseling on pregnancy planning and prevention. Advise male patients of the potential risk of infertility and to seek counseling on fertility and family planning options prior to implantation of GLIADEL Wafer.
WARNINGS AND PRECAUTIONS
Seizures: Seizures occurred in 37% of patients treated with GLIADEL Wafers in the recurrent disease trial. New or worsening (treatment emergent) seizures occurred in 20% of patients; 54% of treatment-emergent seizures occurred within the first 5 post-operative days. The median time to onset of the first new or worsened post-operative seizure was 4 days. Institute optimal anti-seizure therapy prior to surgery. Monitor patients for seizures postoperatively.
Intracranial Hypertension: Brain edema occurred in 23% of patients treated with GLIADEL Wafers in the initial surgery trial. Additionally, one GLIADEL-treated patient experienced intracerebral mass effect unresponsive to corticosteroids which led to brain herniation. Monitor patients closely for intracranial hypertension related to brain edema, inflammation, or necrosis of the brain tissue surrounding the resection. In refractory cases, consider re-operation and removal of GLIADEL Wafers or Wafer remnants.
Impaired Neurosurgical Wound Healing: Impaired neurosurgical wound healing including wound dehiscence, delayed wound healing, and subdural, subgleal, or wound effusions occur with GLIADEL Wafer treatment. In the initial disease trial, 16% of GLIADEL Wafer-treated patients experienced impaired intracranial wound healing and 5% had cerebrospinal fluid leaks. In the recurrent disease trial, 14% of GLIADEL Wafer-treated patients experienced wound healing abnormalities. Monitor patients post-operatively for impaired neurosurgical wound healing.
Meningitis: Meningitis occurred in 4% of patients receiving GLIADEL Wafers in the recurrent disease trial. Two cases of meningitis were bacterial; one patient required removal of the Wafers four days after implantation; the other developed meningitis following reoperation for recurrent tumor. One case was diagnosed as chemical meningitis and resolved following steroid treatment. In one case the cause was unspecified, but meningitis resolved following antibiotic treatment. Monitor postoperatively for signs of meningitis and central nervous system infection.
Wafer Migration: GLIADEL Wafer migration can occur. To reduce the risk of obstructive hydrocephalus due to wafer migration into the ventricular system, close any communication larger than the diameter of a Wafer between the surgical resection cavity and the ventricular system prior to Wafer implantation. Monitor patients for signs of obstructive hydrocephalus.
ADVERSE REACTIONS
The most common adverse reactions in Newly-Diagnosed High Grade Malignant Glioma patients (incidence >10% and between arm difference ≥4%) are cerebral edema, asthenia, nausea, vomiting, constipation, wound healing abnormalities and depression.
The most common adverse reactions in Recurrent Glioblastoma Multiforme patients (incidence >10% and between arm difference ≥4%) are urinary tract infection, wound healing abnormalities and fever.
Please click here for full Prescribing Information.
PP-GLD-US-0210
Gliadel® is manufactured by Eisai Inc. for Arbor Pharmaceuticals, LLC.
Gliadel® is a registered trademark of Eisai Inc.

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