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Talat Kırış - One of the best experts on this subject based on the ideXlab platform.
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Sodium fluorescein-guided brain tumor surgery under the YELLOW-560-nm Surgical Microscope filter in pediatric age group: feasibility and preliminary results.
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2019Co-Authors: Burcu Göker, Talat KırışAbstract:To evaluate the feasibility and safety of sodium fluorescein (Na-Fl)–guided surgery with the use of the PENTERO 900 Surgical Microscope (Carl Zeiss, Meditec, Oberkochen, Germany) equipped with the YELLOW-560-nm filter and low-dose Na-Fl (2 mg/kg) in pediatric brain tumor surgery. The study included 23 pediatric patients with various intracranial pathologies, who underwent Na-Fl-guided surgery between April 2015 and February 2018. Clinical features, Surgical observations, extent of resection, and tumor histopathology were retrospectively analyzed. The use of YELLOW-560-nm filter was found “helpful” if the discrimination of the pinkish brain tissue and bright yellow stained tumor tissue was clear. Otherwise, it was described as “not helpful.” There were 11 female and 12 male patients with a mean age of 9.4 years. There were 7 brain stem/tectal plate gliomas, 6 supratentorial tumors, 4 intraventricular tumors, 2 pineal tumors, 2 infratentorial tumors, 1 clivus tumor, and 1 tumor with supra- and infratentorial extensions in the current series. Na-Fl was found helpful by means of the tumor demarcation in 20 instances (87%). In 11 of these 20 operations (55%), a total resection was achieved regardless of the tumor pathology. A subtotal resection was achieved in the remaining 9 patients (45%). No adverse events or side effects were encountered with regard to Na-Fl use. Na-Fl guidance with the use of the YELLOW-560 filter is safe and effective during brain tumor surgery in pediatric age group.
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Use of Sodium Fluorescein in Meningioma Surgery Performed Under the YELLOW-560 nm Surgical Microscope Filter: Feasibility and Preliminary Results
World neurosurgery, 2017Co-Authors: Mehmet Osman Akçakaya, Burcu Göker, Mustafa Ömür Kasımcan, Mustafa Kemal Hamamcioglu, Talat KırışAbstract:Objective To evaluate the feasibility of sodium fluorescein (Na-Fl)–guided surgery involving the use of the PENTERO 900 Surgical Microscope equipped with the YELLOW-560 nm filter and low-dose Na-FL (200 mg/2–4 mg/kg) in meningioma surgery. Patients and Methods The study included 30 patients with newly diagnosed or recurrent meningiomas who underwent Na-Fl–guided surgery between April 2015 and December 2016. Clinical features, Surgical observations, extent of resection, and tumor histopathology were retrospectively analyzed. The Na-Fl enhancement pattern was assessed as “no enhancement,” “diffuse homogenous enhancement,” or “low heterogeneous enhancement.” Results There were 30 meningiomas among the 30 patients. In 25 patients, Na-Fl was used for tumor demarcation, whereas in 5 patients, it was used for videoangiography. In this series, 88% of tumors showed diffuse homogeneous Na-Fl enhancement during the operation. The resection rate of the meningiomas was 87%. In 5 patients, in whom Na-Fl was used for videoangiography, the approach was useful to evaluate Na-Fl-stained vessels for patency and to understand their relationship with the tumor. No adverse events were encountered with regard to Na-Fl use. Conclusions Na-Fl guidance with the use of the YELLOW-560 filter is safe and effective during meningioma surgery.
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The use of the YELLOW 560 nm Surgical Microscope filter for sodium fluorescein-guided resection of brain tumors: Our preliminary results in a series of 28 patients.
Clinical neurology and neurosurgery, 2016Co-Authors: Mustafa Kemal Hamamcioglu, Mehmet Osman Akçakaya, Burcu Göker, Mustafa Ömür Kasımcan, Talat KırışAbstract:Abstract Objective Sodium fluorescein (Na-Fl) is a fluorescent dye that accumulates in tumoral tissues via disrupted blood-brain barrier. It has been used in fluorescence-guided surgery for various brain tumors. Herein, we report our initial experience and preliminary results for the first 28 patients who were operated on under Na-Fl guidance with the use of a special filter on the Surgical Microscope. Patient and methods Between January and November 2015, 200 mg (2–4 mg/kg) of Na-Fl was administered in 28 patients (30 surgeries) after anesthesia induction. The clinical features, Surgical observations, extent of resection on the postoperative magnetic resonance imaging (MRI) and histopathology of the tumors were retrospectively analyzed. The use of YELLOW 560 nm filter was found “helpful” if the discrimination of the pinkish brain tissue and bright yellow stained tumor tissue was clear. Otherwise, it was described as “not helpful. Results There were 23 high-grade and 7 metastatic tumors in our study group. Na-Fl was found helpful by means of the tumor demarcation in 29 of 30 operations (97%). In 23 of these 29 operations (79%), a total resection was achieved regardless of the tumor pathology. No adverse events were encountered regarding the use of Na-Fl. Conclusion Na-Fl guidance with the use of a YELLOW 560 filter is safe and effective in high-grade glioma and metastatic tumor surgery. We think it is feasible for increasing the extent of resection in these tumors.
Robert F Spetzler - One of the best experts on this subject based on the ideXlab platform.
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prospective evaluation of Surgical Microscope integrated intraoperative near infrared indocyanine green videoangiography during aneurysm surgery
Journal of Neurosurgery, 2005Co-Authors: Andreas Raabe, Jurgen Beck, Volker Seifert, Peter Nakaji, Jonathan D Kamerman, Robert F SpetzlerAbstract:Object. The authors prospectively compared a new technique of Surgical Microscope-based indocyanine green (ICG) videoangiography with intraoperative or postoperative digital subtraction (DS) angiography. Method. The technique was performed during 187 Surgical procedures in which 124 aneurysms in 114 patients were clipped. Using a newly developed setup, the ICG technique has been integrated into an operating Microscope (Carl Zeiss Co., Oberkochen, Germany). A Microscope-integrated light source containing infrared excitation light illuminates the operating field. The dye is injected intravenously into the patient, and intravascular fluorescence from within the blood vessels is imaged using a video camera attached to the Microscope. The patency of parent, branching, and perforating arteries and documentation of clip occlusion of the aneurysm as shown by ICG videoangiography were compared with intraoperative or postoperative findings on DS angiography. The results of ICG videoangiography corresponded with int...
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Prospective evaluation of Surgical Microscope—integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery
Journal of neurosurgery, 2005Co-Authors: Andreas Raabe, Jurgen Beck, Volker Seifert, Peter Nakaji, Jonathan D Kamerman, Louis J. Kim, Frank P.k. Hsu, Robert F SpetzlerAbstract:Object. The authors prospectively compared a new technique of Surgical Microscope-based indocyanine green (ICG) videoangiography with intraoperative or postoperative digital subtraction (DS) angiography. Method. The technique was performed during 187 Surgical procedures in which 124 aneurysms in 114 patients were clipped. Using a newly developed setup, the ICG technique has been integrated into an operating Microscope (Carl Zeiss Co., Oberkochen, Germany). A Microscope-integrated light source containing infrared excitation light illuminates the operating field. The dye is injected intravenously into the patient, and intravascular fluorescence from within the blood vessels is imaged using a video camera attached to the Microscope. The patency of parent, branching, and perforating arteries and documentation of clip occlusion of the aneurysm as shown by ICG videoangiography were compared with intraoperative or postoperative findings on DS angiography. The results of ICG videoangiography corresponded with int...
Jeehyun Kim - One of the best experts on this subject based on the ideXlab platform.
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In vivo imaging of middle-ear and inner-ear microstructures of a mouse guided by SD-OCT combined with a Surgical Microscope.
Optics express, 2014Co-Authors: Nam Hyun Cho, Jeong Hun Jang, Woonggyu Jung, Jeehyun KimAbstract:We developed an augmented-reality system that combines optical coherence tomography (OCT) with a Surgical Microscope. By sharing the common optical path in the Microscope and OCT, we could simultaneously acquire OCT and Microscope views. The system was tested to identify the middle-ear and inner-ear microstructures of a mouse. Considering the probability of clinical application including otorhinolaryngology, diseases such as middle-ear effusion were visualized using in vivo mouse and OCT images simultaneously acquired through the eyepiece of the Surgical Microscope during Surgical manipulation using the proposed system. This system is expected to realize a new practical area of OCT application.
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Stimulated penetrating keratoplasty using real-time virtual intraoperative Surgical optical coherence tomography
Journal of biomedical optics, 2014Co-Authors: Changho Lee, Woonggyu Jung, Kyung-un Kim, Seunghoon Han, Sehui Kim, Jun Hoon Lee, Hong Kyun Kim, Chulhong Kim, Jeehyun KimAbstract:An intraoperative Surgical Microscope is an essential tool in a neuro- or ophthalmological Surgical environment. Yet, it has an inherent limitation to classify subsurface information because it only provides the surface images. To compensate for and assist in this problem, combining the Surgical Microscope with optical coherence tomography (OCT) has been adapted. We developed a real-time virtual intraoperative Surgical OCT (VISOCT) system by adapting a spectral-domain OCT scanner with a commercial Surgical Microscope. Thanks to our custom-made beam splitting and image display subsystems, the OCT images and microscopic images are simultaneously visualized through an ocular lens or the eyepiece of the Microscope. This improvement helps surgeons to focus on the operation without distraction to view OCT images on another separate display. Moreover, displaying the OCT live images on the eyepiece helps surgeon’s depth perception during the surgeries. Finally, we successfully processed stimulated penetrating keratoplasty in live rabbits. We believe that these technical achievements are crucial to enhance the usability of the VISOCT system in a real Surgical operating condition.
Andreas Raabe - One of the best experts on this subject based on the ideXlab platform.
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technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using Surgical Microscope integrated near infrared video technology
Neurochirurgie, 2006Co-Authors: Andreas Raabe, Jurgen Beck, Volker SeifertAbstract:Objective To describe the technical integration of indocyanine green (ICG) near-infrared technology into the optical path of the Surgical Microscope and to report on the image quality achieved by this method. We hypothesized that ICG angiography permits a simple and quick intraoperative assessment of vessel patency and aneurysm occlusion after clip placement. Methods A special arrangement of filters was designed to allow the passage of near-infrared light required for the excitation of ICG fluorescence (700-850 nm) from a modified Microscope light source into the Surgical field and the passage of ICG fluorescence (780-950 nm) from the Surgical field back into the optical path of the Surgical Microscope (Carl Zeiss, Oberkochen, Germany). Thus, ICG angiography could be completely performed with a Surgical Microscope. 20 patients with intracranial aneurysms were included in the technical evaluation of the new method. Results Image quality and spatial resolution were excellent and permitted a real-time assessment of vessel patency and aneurysm occlusion if the structures of interest were visible to the surgeon's eye under the Microscope, including perforating arteries with a diameter of less than 1 millimeter. In 1 patient, vessel occlusion by the clip was found and in 1 case residual filling of the aneurysm was diagnosed. Both cases could be treated by clip correction within 2 minutes after primary placement of the clip. In all cases, the intraoperative findings correlated with the postoperative digital subtraction angiography. Conclusions ICG angiography using a Surgical Microscope is valuable for the intraoperative imaging of arterial and venous flow in all visible vessels including small perforating arteries. The simplicity of the method and the speed with which the investigation can be performed indicate that this technique may help to improve the quality and outcome of Surgical procedures and reduce the need for intra- or postoperative angiography in selected cases.
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prospective evaluation of Surgical Microscope integrated intraoperative near infrared indocyanine green videoangiography during aneurysm surgery
Journal of Neurosurgery, 2005Co-Authors: Andreas Raabe, Jurgen Beck, Volker Seifert, Peter Nakaji, Jonathan D Kamerman, Robert F SpetzlerAbstract:Object. The authors prospectively compared a new technique of Surgical Microscope-based indocyanine green (ICG) videoangiography with intraoperative or postoperative digital subtraction (DS) angiography. Method. The technique was performed during 187 Surgical procedures in which 124 aneurysms in 114 patients were clipped. Using a newly developed setup, the ICG technique has been integrated into an operating Microscope (Carl Zeiss Co., Oberkochen, Germany). A Microscope-integrated light source containing infrared excitation light illuminates the operating field. The dye is injected intravenously into the patient, and intravascular fluorescence from within the blood vessels is imaged using a video camera attached to the Microscope. The patency of parent, branching, and perforating arteries and documentation of clip occlusion of the aneurysm as shown by ICG videoangiography were compared with intraoperative or postoperative findings on DS angiography. The results of ICG videoangiography corresponded with int...
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Prospective evaluation of Surgical Microscope—integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery
Journal of neurosurgery, 2005Co-Authors: Andreas Raabe, Jurgen Beck, Volker Seifert, Peter Nakaji, Jonathan D Kamerman, Louis J. Kim, Frank P.k. Hsu, Robert F SpetzlerAbstract:Object. The authors prospectively compared a new technique of Surgical Microscope-based indocyanine green (ICG) videoangiography with intraoperative or postoperative digital subtraction (DS) angiography. Method. The technique was performed during 187 Surgical procedures in which 124 aneurysms in 114 patients were clipped. Using a newly developed setup, the ICG technique has been integrated into an operating Microscope (Carl Zeiss Co., Oberkochen, Germany). A Microscope-integrated light source containing infrared excitation light illuminates the operating field. The dye is injected intravenously into the patient, and intravascular fluorescence from within the blood vessels is imaged using a video camera attached to the Microscope. The patency of parent, branching, and perforating arteries and documentation of clip occlusion of the aneurysm as shown by ICG videoangiography were compared with intraoperative or postoperative findings on DS angiography. The results of ICG videoangiography corresponded with int...
Cynthia A Toth - One of the best experts on this subject based on the ideXlab platform.
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Integration of a Spectral Domain Optical Coherence Tomography System into a Surgical Microscope for Intraoperative Imaging
Investigative ophthalmology & visual science, 2011Co-Authors: Justis P Ehlers, Yuankai K. Tao, Sina Farsiu, Ramiro S Maldonado, Joseph A Izatt, Cynthia A TothAbstract:Over the years, multiple milestones have revolutionized vitreoretinal surgery. The x–y Surgical Microscope control, wide-angle viewing, and fiberoptic illumination are all examples of instrumentation that have been integrated to radically improve pars plana vitreoretinal surgery.1–6 A major advance in vitreoretinal surgery may be the integration of retinal imaging into the operating room. Optical coherence tomography (OCT) has dramatically increased the efficacy of treatment of ophthalmic disease through improvement in diagnosis, understanding of pathophysiology, and monitoring of progression over time. Its ability to provide a high-resolution, cross-sectional, three-dimensional view of the relationships of vitreoretinal anatomy during surgery makes intraoperative OCT a logical complement to the vitreoretinal surgeon. Early attempts at intraoperative OCT have already improved our understanding of the feasibility of intraoperative management and the role it might play in Surgical decision-making. Epiretinal membrane (ERM) relationships, macular hole configurations, optic pit characteristics, retinal detachment features, and features of retinopathy of prematurity (ROP) have all been described by means of intraoperative OCT (Lee LB, et al. IOVS 2010;51:ARVO E-Abstract 6076).7–10 One major limitation of intraoperative OCT is the availability of a device that integrates OCT capability into the operating Microscope. Until now, published studies have used an OCT system separate from the operating Microscope for imaging during surgery or for examination of patients under anesthesia.7–10 When the current systems are used for intraoperative scanning, surgery must be halted while the scans are performed. Thus, one can image retinal architecture and vitreoretinal relationships after manipulations, but cannot obtain real-time OCT imaging of actual tissue manipulation. The ideal device would provide a real-time platform for true intraoperative feedback to the surgeon. This approach would require device integration with the Microscope, to allow for OCT scanning during surgery and should provide the surgeon with OCT visualization without interfering with the view of the real-time operative field. In addition, Surgical instrumentation should be visible on OCT imaging while not obstructing the view of the underlying tissues. In this study, we developed and tested a prototype Microscope-mounted spectral domain (SD)OCT device to evaluate its potential for use in retinal microsurgery on the posterior pole. We also characterized the OCT appearance of the current armamentarium of instruments to better understand what is required for a fully integrated operative system, including the operative Microscope, SDOCT, and OCT-compatible instrumentation.
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integration of a spectral domain optical coherence tomography system into a Surgical Microscope for intraoperative imaging
Investigative Ophthalmology & Visual Science, 2011Co-Authors: Justis P Ehlers, Sina Farsiu, Ramiro S Maldonado, Joseph A Izatt, Cynthia A TothAbstract:Over the years, multiple milestones have revolutionized vitreoretinal surgery. The x–y Surgical Microscope control, wide-angle viewing, and fiberoptic illumination are all examples of instrumentation that have been integrated to radically improve pars plana vitreoretinal surgery.1–6 A major advance in vitreoretinal surgery may be the integration of retinal imaging into the operating room. Optical coherence tomography (OCT) has dramatically increased the efficacy of treatment of ophthalmic disease through improvement in diagnosis, understanding of pathophysiology, and monitoring of progression over time. Its ability to provide a high-resolution, cross-sectional, three-dimensional view of the relationships of vitreoretinal anatomy during surgery makes intraoperative OCT a logical complement to the vitreoretinal surgeon. Early attempts at intraoperative OCT have already improved our understanding of the feasibility of intraoperative management and the role it might play in Surgical decision-making. Epiretinal membrane (ERM) relationships, macular hole configurations, optic pit characteristics, retinal detachment features, and features of retinopathy of prematurity (ROP) have all been described by means of intraoperative OCT (Lee LB, et al. IOVS 2010;51:ARVO E-Abstract 6076).7–10 One major limitation of intraoperative OCT is the availability of a device that integrates OCT capability into the operating Microscope. Until now, published studies have used an OCT system separate from the operating Microscope for imaging during surgery or for examination of patients under anesthesia.7–10 When the current systems are used for intraoperative scanning, surgery must be halted while the scans are performed. Thus, one can image retinal architecture and vitreoretinal relationships after manipulations, but cannot obtain real-time OCT imaging of actual tissue manipulation. The ideal device would provide a real-time platform for true intraoperative feedback to the surgeon. This approach would require device integration with the Microscope, to allow for OCT scanning during surgery and should provide the surgeon with OCT visualization without interfering with the view of the real-time operative field. In addition, Surgical instrumentation should be visible on OCT imaging while not obstructing the view of the underlying tissues. In this study, we developed and tested a prototype Microscope-mounted spectral domain (SD)OCT device to evaluate its potential for use in retinal microsurgery on the posterior pole. We also characterized the OCT appearance of the current armamentarium of instruments to better understand what is required for a fully integrated operative system, including the operative Microscope, SDOCT, and OCT-compatible instrumentation.
