ORL & Maxilo Facial




                      MAG 2008 Page 1
Pourquoi utiliser la navigation en ORL?


· Une resection plus complète des tissus malades (ex: Polype) Le chirurgien peut...
Sommaire

A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Logiciel de navigation ...
BrainLAB
                                                       •   3,000 hopitaux utilisant des logiciels
               ...
Integrated Neuroscience Center

     Etapes de developpement                                                              ...
Centre de Neuroscience integré




                                 MAG 2008 Page 6
Debloquer les possibilités pour les patients et le staff

                                                 Oncologie
     ...
Imagerie Intra-operatoire– 1.5T iMRI
BrainSUITE® iMRI sallle d´opération integré




•   Enregistrement automatisé du pati...
Negatoscope numérique – Digital Lightbox




                                           MAG 2008 Page 9
Sommaire

A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Logiciel de navigation ...
Technologie a marqueurs passifs

Technique
•   Camera envoie des signaux infrarouge
•   Les spheres reflechissantes reflec...
Platformes

Tous les systèmes utilisent
•   Techonolgie avec marqueur passif
•   Les memes fonctionalités logicielle




 ...
Sommaire

A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Logiciel de navigation ...
Logiciel de plannification pre-opératoire iPlan
1st step: Frankfort Horizontal
                                           ...
Logiciel de plannification pre-opératoire iPlan
2nd step: Segmentation of objects
                                        ...
Logiciel de plannification pre-opératoire iPlan
2nd step: Semiautomatic Segmentation
                                     ...
Logiciel de plannification pre-opératoire iPlan
3rd step: Mirroring of segmented objects
                                 ...
Indication: Movement of fragments
Movement of copied objects


                              •   The copied object can be ...
Résumé de la plannification pre-operatoire



                                •   Semiautomatic Image Fusion – also for
  ...
Particularité BrainLAB: La plannif maxilo faciale
 • Frankfort Horizontal alignment brings the patient’s head in a natural...
Workflow – 4 étapes pour la navigation per-opératoire




                                               MAG 2008 Page 21
Sommaire

A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Navigation per-opératoi...
Navigation per-operatoire
1st step: Preoperative Scan
                                        •   Utilization of preoperat...
Navigation per-operatoire
2nd step: Intraoperative preparation – Patient reference star
                                No...
Navigation per-operatoire
3rd step: intraoperative registration
•   Surface scanning with a laser
•   No given registratio...
Navigation per-operatoire
4th step: Navigation




  Benefit: Time saving setup and workflow as well as advanced functiona...
Navigation per-operatoire
4th step: Instrument integration
•   Simple integration of all instruments
•   Different geometr...
Navigation per-operatoire
Image integration




  Benefit: Video integration endoscope and micorscope as well as image
   ...
Navigation per-operatoire
Advanced features
                                             Eraser
                          ...
Résumé de la navigation per-opératoire



                               •   Platforms according to needs


              ...
Conclusion




             MAG 2008 Page 31
Conclusion

  BrainLAB offre une solution pour la navigation et la plannification ORL


  La plannification CMF est une op...
…merci!




          MAG 2008 Page 33
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Presentation ORL / CMF 2008

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Presentation ORL / CMF 2008

  1. 1. ORL & Maxilo Facial MAG 2008 Page 1
  2. 2. Pourquoi utiliser la navigation en ORL? · Une resection plus complète des tissus malades (ex: Polype) Le chirurgien peut etre plus “agressif” avec une navigation · Un taux de 2nd operation diminué · Evite les complications chirurgicales · Augmenter la sécurité et l´efficacité dans le geste · Extrement utile si un repère anatomique a été enlevé lors d´une chirurgie précédente MAG 2008 Page 2
  3. 3. Sommaire A propos de BrainLAB Technologie et plateform Logiciel de plannnification pre-opératoire Logiciel de navigation per-opératoire MAG 2008 Page 3
  4. 4. BrainLAB • 3,000 hopitaux utilisant des logiciels BrainLAB • Clients dans plus de 75 pays • 1000 employés dans 16 bureau de par le monde • 230 ingénieurs R&D • 200 Ingénieurs services • 3,300 Logiciels installés • Plus de 350 installations en ORL et CMF New BrainLAB headquarters in Feldkirchen near Munich • Nouveau developpement pour la plannification Maxilo facial depuis 2005 MAG 2008 Page 4
  5. 5. Integrated Neuroscience Center Etapes de developpement 2008 2007 FiberTracking 2006 Novalis® Tx Laser-based 2005 surface registration BrainSUITE® iCT Integrated radiosurgery 2003 system 2001 1998 BrainSUITE® iMRI 3D visualization software 1997 Cranial planning & navigation 1993 1990 Stereotactic radiosurgery hardware MAG 2008 Page 5
  6. 6. Centre de Neuroscience integré MAG 2008 Page 6
  7. 7. Debloquer les possibilités pour les patients et le staff Oncologie Neurochirurgie Salle op integré Rachis & Trauma Orthopédie Radiologie Pharmaceutique ORL MAG 2008 Page 7
  8. 8. Imagerie Intra-operatoire– 1.5T iMRI BrainSUITE® iMRI sallle d´opération integré • Enregistrement automatisé du patient et transfert des scans inter-opératoires. • Integration de la gestion des données et visualisation permettant d´améliorer le processus de decision • Opérations en dehors de la ligne de 5 Gauss utilisant des instruments chirurgicaux normaux. MAG 2008 Page 8
  9. 9. Negatoscope numérique – Digital Lightbox MAG 2008 Page 9
  10. 10. Sommaire A propos de BrainLAB Technologie et plateform Logiciel de plannnification pre-opératoire Logiciel de navigation per-opératoire MAG 2008 Page 10
  11. 11. Technologie a marqueurs passifs Technique • Camera envoie des signaux infrarouge • Les spheres reflechissantes reflechis le signal • La camera recoit le signal en retour Votre bénéfice • Localisation précise de tous les instruments sans erreur • Pas de d´emmetteur ou recepteur supplémentaire MAG 2008 Page 11
  12. 12. Platformes Tous les systèmes utilisent • Techonolgie avec marqueur passif • Les memes fonctionalités logicielle MAG 2008 Page 12
  13. 13. Sommaire A propos de BrainLAB Technologie et plateform Logiciel de plannnification pre-opératoire Logiciel de navigation per-opératoire MAG 2008 Page 13
  14. 14. Logiciel de plannification pre-opératoire iPlan 1st step: Frankfort Horizontal • Landmark based definition of Frankfort Horizontal and Midsagital Plane in 2D and 3D. • Dataset is aligned to defined Planes • Planes and Alignment necessary to be able to mirror the segmented objects from healthy to defect side Benefit: Fast and easy definition of planes for mirroring and alignment of the dataset MAG 2008 Page 14
  15. 15. Logiciel de plannification pre-opératoire iPlan 2nd step: Segmentation of objects • Several methods of Segmentation: •Semiautomatic Segmentation •Segmentation Slice by Slice with Brush •Usingof Seed Brush (segments areas with same Houndfield units) • Semi-automatic segmentation as fastest option to segment bony structures. Benefit: Several options of segmentation depending on preferences and indication. MAG 2008 Page 15
  16. 16. Logiciel de plannification pre-opératoire iPlan 2nd step: Semiautomatic Segmentation • Segmentation by definition of region of interest in each view • Only the red highlighted structures will be segmented • Changing of Houndsfield Units until structures of interested are highlighted red Benefit: Most time saving and easiest option of Object Segmentation which is superior over time consuming standard segmentation slice by slice MAG 2008 Page 16
  17. 17. Logiciel de plannification pre-opératoire iPlan 3rd step: Mirroring of segmented objects • Healthy side is used as template for defect side. • Object is mirrored at the prior defined Midsagital plane Benefit: Time saving creation of templates for reconstruction of defect side MAG 2008 Page 17
  18. 18. Indication: Movement of fragments Movement of copied objects • The copied object can be moved in any direction • The movement is done in the 2D views MAG 2008 Page 18
  19. 19. Résumé de la plannification pre-operatoire • Semiautomatic Image Fusion – also for postoperative control • Definition of Midsagital • Semiautomatic Segmentation • Advanced Object Planning (Mirroring) MAG 2008 Page 19
  20. 20. Particularité BrainLAB: La plannif maxilo faciale • Frankfort Horizontal alignment brings the patient’s head in a natural position. • In most cases only one part of the face is affected -so we can use the remaining as a contour template. => Use of miroring function • If both sides are affected, the Software can be used as planning tool for repositioning of big fragments or to plan a model of an implant which can be exported with a STL –Export (next Version). • Another major field is implanting of dental. It is possible to plan them with trajectories and dental implants can be imported and planned via STL-Import (next version) • With iPlan CMFsurgeons can plan the intervention safe different states and come back later for refinements. • Now they can virtually plan the treatment or try out new reconstructive techniques without touching the patient. • With the support of an atlas they don‘t need to outline typical structures, iPlan makes it as easy and fast as possible to generate a treatment template • With the support of our navigation systems the reconstructions are more precise and more accurate than before. Now the surgeon can operate in areas where that he wouldn‘t have touched without the support of BrainLAB‘s advanced technology. MAG 2008 Page 20
  21. 21. Workflow – 4 étapes pour la navigation per-opératoire MAG 2008 Page 21
  22. 22. Sommaire A propos de BrainLAB Technologie et plateform Logiciel de plannnification pre-opératoire Navigation per-opératoire MAG 2008 Page 22
  23. 23. Navigation per-operatoire 1st step: Preoperative Scan • Utilization of preoperative scans – no navigation scan necessary • No fiducials necessary Benefit: Reduction of radiation dose for patient MAG 2008 Page 23
  24. 24. Navigation per-operatoire 2nd step: Intraoperative preparation – Patient reference star Non-invasive referencing with headband - generally used for sinus surgery in ENT Minimal invasive referencing in bone structure - generally used for skull base surgery, lateral indications or CMF cases Benefit: Referencing according to needs and indication. MAG 2008 Page 24
  25. 25. Navigation per-operatoire 3rd step: intraoperative registration • Surface scanning with a laser • No given registration points or registration routes • Registration accomplished in one minute • Registration possible in a sterile environment Benefit: Touchless registration saves sterile environment. MAG 2008 Page 25
  26. 26. Navigation per-operatoire 4th step: Navigation Benefit: Time saving setup and workflow as well as advanced functionalities MAG 2008 Page 26
  27. 27. Navigation per-operatoire 4th step: Instrument integration • Simple integration of all instruments • Different geometries of stars and adapter clamps fit on every instrument Benefit: Fast integration of every rigid instrument available in the OR MAG 2008 Page 27
  28. 28. Navigation per-operatoire Image integration Benefit: Video integration endoscope and micorscope as well as image injection in microscopes MAG 2008 Page 28
  29. 29. Navigation per-operatoire Advanced features Eraser Intraoperative Imaging • Virtual anatomical update of structures Ultrasound integration • Tip of instrumentintegrated ultrasound IGSonic as fully is tracked device • Removed tissue can be visualized • virtually Other imaging devices like C-arms • First step to real intraoperative imaging Benefit: From essential navigation to unlimited functionalities MAG 2008 Page 29
  30. 30. Résumé de la navigation per-opératoire • Platforms according to needs • Data acquisition • Referencing • Registration • Navigation and Integration MAG 2008 Page 30
  31. 31. Conclusion MAG 2008 Page 31
  32. 32. Conclusion BrainLAB offre une solution pour la navigation et la plannification ORL La plannification CMF est une option de la partie ORL BrainLAB est le seul vendeur majeur proposant une véritable plannification CMF, prenant en compte les implants La plannification et la plateforme de navigation sont concues pour recevoir d´autres spécialités (Neuro, ortho, Etc.) MAG 2008 Page 32
  33. 33. …merci! MAG 2008 Page 33

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