Virtual neurosurgery, training for the future

Virtual reality (VR) simulators have been created for various surgical specialties. The common theme is extensive use of graphics, confined spaces, limited functionality and limited tactile feedback. A development team at the University of Nottingham, UK, consisting of computer scientists, mechanical engineers, graphic designers and a neurosurgeon, set out to develop a haptic, e.g. tactile simulator for neurosurgery making use of boundary elements (BE). The relative homogeneity of the brain, allows boundary elements, e.g. 'surface only' rendering, to simulate the brain structure. A boundary element simplifies the computing equations saves computing time, by assuming the properties of the surface equal the properties of the body. A limited audit was done by neurosurgical users confirming the potential of the simulator as a training tool. This paper focuses on the application of the computational method and refers to the underlying mathematical structure. Full references are included regarding the mathematical methodology.     

The future of neurosurgery

Summary Many factors influence the future of neurosurgery, among them the general growth of the world population with an increasing number of older persons and the political-economical development which differs markedly from region to region.Another important factor will be the biological and molecular revolution which has just begun and makes it likely, that some of the pathologies, which needed neurosurgical management, become accessable to conservative treatment in the future.Finally the neurosurgical sphere of activity is endangered by takeover tendencies of neighbouring medical specialties.Those of us who are in charge of neurosurgical organization and planning should take these and additional factors into consideration early enough, in order to give neurosurgery and neurosurgeons a chance to adapt to the future.Invited Lecture, presented at the European Congress of Neurosurgery, Moscow, June 23–28, 1991.     

In vivo laparoscopic robotics

Robotic laparoscopic surgery is evolving to include in vivo robotic assistants. The impetus for the development of this technology is to provide surgeons with additional viewpoints and unconstrained manipulators that improve safety and reduce patient trauma. A family of these robots have been developed to provide vision and task assistance. Fixed-base and mobile robots have been designed and tested in animal models with much success. A cholecystectomy, prostatectomy, and nephrectomy have all been performed with the assistance of these robots. These early successful tests show how in vivo laparoscopic robotics may be part of the next advancement in surgical technology.     

术中磁共振成像在神经外科中的发展及现状

近20年来随着物理学、材料学、微电子学、计算机以及生物学发展,使得微侵袭理念或理论日益完善,并开发出多个神经外科微侵袭技术平台,包括:显微解剖及神经外科、神经内镜(脑室镜及脊柱内镜)、影像引导外科(IGS)、立体定向神经外科(包括间质内介入治疗)、血管内介入神经外科、术中神经电生理监测、放射神经外科及分子和干细胞神经外科.其中进展最快、技术含量最高的即是IGS,IGS 的核心在于将术中病灶及注册后手术器械位置同步显示于术前或术中的影像学图像上,用以指引手术医师处理病灶[1];基于此,IGS所应用的技术有神经导航系统及手术机器人系统.     

Biological plasticity: the future of science in neurosurgery

THE FUTURE OF neurosurgery is intimately related to the future of neuroscientific research. Although the field of neuroscience is immense and not subject to brief review, it is clear that certain trends have become critical to future thinking regarding neurosurgery. An important theme that recurs in much of the current research and that will become more prominent in the future is the concept of plasticity. This refers not only to the changes in cortical representation that can occur after a variety of perturbations but also to a wide variety of neurologically relevant biological processes. In this review, we describe three areas of plasticity, i.e., the response of the brain to ischemia, cortical representational changes, and the potential for stem cell biological processes to allow us to manipulate plasticity. We posit that these trends will be crucial to the future of our specialty.     

Spine surgical robotics: review of the current application and disadvantages for future perspectives

Journal of Robotic Surgery - In the past decade, intelligent medical technology has been a hot research direction, which results in a series of products such as image-assisted AI and tumor...     

The future of robotics in hand surgery

Robotics has spread over many surgical fields over the last decade: orthopaedic, cardiovascular, urologic, gynaecologic surgery and various other types of surgery. There are five different types of robots: passive, semiactive and active robots, telemanipulators and simulators. Hand surgery is at a crossroad between orthopaedic surgery, plastic surgery and microsurgery; it has to deal with fixing all sorts of tissues from bone to soft tissues. To our knowledge, there is not any paper focusing on potential clinical applications in this realm, even though robotics could be helpful for hand surgery. One must point out the numerous works on bone tissue with regard to passive robots (such as fluoroscopic navigation as an ancillary for percutaneous screwing in the scaphoid bone). Telemanipulators, especially in microsurgery, can improve surgical motion by suppressing physiological tremor thanks to movement demultiplication (experimental vascular and nervous sutures previously published). To date, the robotic technology has not yet become simple-to-use, cheap and flawless but in the future, it will probably be of great technical help, and even allow remote-controlled surgery overseas.     

Networked robotics: its present status and future prospect]

One of the most promising technologies today is the integration of virtual reality and robotics on a network. This is called network robotics in general and R-cubed (real-time remote robotics) in particular. R-cubed is a Japanese national R&D scheme to realize augmented telexistence (tele-existence) through various kinds of networks including the Internet. Telexistence is a concept named for the technology that enables people to have a real-time sensation of being present at a location other than the place where they actually exist, and to interact with a remote and/or virtual environment. They can thus "telexist" in a real environment that the robot is present or in a virtual environment that a computer has generated. It is also possible to telexist in a mixed environment of real and virtual which can be called augmented telexistence. The concept of telexistence, i.e., virtual existence in a remote or computer-generated environment, has developed into the national R-cubed R&D scheme to create an advanced and comfortable life for the network society of the 21st century. Based on the national R&D scheme of R-Cubed, the Humanoid Robotics Project (HRP) was launched in April 1998. This is an effort to integrate telerobotics, network technology, and virtual reality into networked telexistence, and significant results are expected.     

The future of neurosurgery: a white paper on the recruitment and retention of women in neurosurgery

PREFACE: The leadership of Women in Neurosurgery (WINS) has been asked by the Board of Directors of the American Association of Neurological Surgeons (AANS) to compose a white paper on the recruitment and retention of female neurosurgical residents and practitioners. INTRODUCTION: Neurosurgery must attract the best and the brightest. Women now constitute a larger percentage of medical school classes than men, representing approximately 60% of each graduating medical school class. Neurosurgery is facing a potential crisis in the US workforce pipeline, with the number of neurosurgeons in the US (per capita) decreasing. WOMEN IN THE NEUROSURGERY WORKFORCE: The number of women entering neurosurgery training programs and the number of board-certified female neurosurgeons is not increasing. Personal anecdotes demonstrating gender inequity abound among female neurosurgeons at every level of training and career development. Gender inequity exists in neurosurgery training programs, in the neurosurgery workplace, and within organized neurosurgery. OBSTACLES: The consistently low numbers of women in neurosurgery training programs and in the workplace results in a dearth of female role models for the mentoring of residents and junior faculty/practitioners. This lack of guidance contributes to perpetuation of barriers to women considering careers in neurosurgery, and to the lack of professional advancement experienced by women already in the field. There is ample evidence that mentors and role models play a critical role in the training and retention of women faculty within academic medicine. The absence of a critical mass of female neurosurgeons in academic medicine may serve as a deterrent to female medical students deciding whether or not to pursue careers in neurosurgery. There is limited exposure to neurosurgery during medical school. Medical students have concerns regarding gender inequities (acceptance into residency, salaries, promotion, and achieving leadership positions). Gender inequity in academic medicine is not unique to neurosurgery; nonetheless, promotion to full professor, to neurosurgery department chair, or to a national leadership position is exceedingly rare within neurosurgery. Bright, competent, committed female neurosurgeons exist in the workforce, yet they are not being promoted in numbers comparable to their male counterparts. No female neurosurgeon has ever been president of the AANS, Congress of Neurological Surgeons, or Society of Neurological Surgeons (SNS), or chair of the American Board of Neurological Surgery (ABNS). No female neurosurgeon has even been on the ABNS or the Neurological Surgery Residency Review Committee and, until this year, no more than 2 women have simultaneously been members of the SNS. Gender inequity serves as a barrier to the advancement of women within both academic and community-based neurosurgery. STRATEGIC APPROACH TO ADDRESS ISSUES IDENTIFIED: To overcome the issues identified above, the authors recommend that the AANS join WINS in implementing a strategic plan, as follows: 1) Characterize the barriers. 2) Identify and eliminate discriminatory practices in the recruitment of medical students, in the training of residents, and in the hiring and advancement of neurosurgeons. 3) Promote women into leadership positions within organized neurosurgery. 4) Foster the development of female neurosurgeon role models by the training and promotion of competent, enthusiastic, female trainees and surgeons.     

The circumventricular organs of the brain: their role as possible sites for future neurosurgery

In this paper an attempt is made to give an account of the possible significance of the circumventricular organs to the neurosurgeon. Two major members of the group, the neurohypophysis and the pineal organ, are not considered, largely because of the vast literature which has already accrued on these two structures. Particular attention is paid to the relationship between the circulation of the cerebrospinal fluid and the problem of hydrocephalus, the choroid plexus, and the possible roles of Reissner's fibre and the subcommissural organ.