INTRODUCTION: Frameless stereotactic brain biopsy systems are widely used today. VarioGuide (VG) is a relatively novel frameless system. Its accuracy was studied in a laboratory setting but has not yet been studied in the clinical setting. The purpose of this study was to determine its accuracy and diagnostic yield and to compare this with frame-based (FB) stereotaxy. MATERIAL AND METHODS: Overall, 53 patients (33 males and 20 females, 60 ± 15 years old) were enrolled into this prospective, randomized, single-center study. Twenty-six patients were randomized into the FB group and 27 patients into the VG group. Real trajectory was pointed on intraoperative magnetic resonance. The distance of the targets and angle deviation between the planned and real trajectories were computed. The overall discomfort of the patient was subjectively assessed by the visual analog scale score. RESULTS: The median lesion volume was 5 mL (interquartile range [IQR]: 2-16 mL) (FB) and 16 mL (IQR: 2-27 mL) (VG), P = 0.133. The mean distance of the targets was 2.7 ± 1.1 mm (FB) and 2.9 ± 1.3 mm (VG), P = 0.456. Mean angle deviation was 2.6 ± 1.3 deg (FB) and 3.5 ± 2.1 deg (VG), P = 0.074. Diagnostic yield was 93% (25/27) in VG and 96% (25/26) in FB, P = 1.000. Mean operating time was 47 ± 26 minutes (FB) and 59 ± 31 minutes (VG), P = 0.140. One minor bleeding was encountered in the VG group. Overall patient discomfort was significantly higher in the FB group (visual analog scale score 2.5 ± 2.1 vs. 1.2 ± 0.6, P = 0,004). CONCLUSIONS: The VG system proved to be comparable in terms of the trajectory accuracy, rate of complications and diagnostic yield compared with the "gold standard" represented by the traditional FB stereotaxy for patients undergoing brain biopsy. VG is also better accepted by patients.

• Klíčová slova
• Accuracy, Brain biopsy, Clinical outcome, Diagnostic yield, Frame-based stereotaxy, Frameless stereotaxy, Intraoperative magnetic resonance,
• MeSH
• biopsie přístrojové vybavení   MeSH
• design vybavení MeSH
• diferenciální diagnóza MeSH
• dospělí MeSH
• interpretace obrazu počítačem přístrojové vybavení   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie přístrojové vybavení   MeSH
• mozek patologie   MeSH
• nádory mozku patologie   sekundární   chirurgie   MeSH
• neuronavigace přístrojové vybavení   MeSH
• odchylka pozorovatele MeSH
• počítačová rentgenová tomografie MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: Navigation based on an intraoperative CT scan is not a new approach to spinal instrumentation. Innovative intraoperative imaging technology, however, opens new horizons to more precise image acquisition as well as to further workflow. Planning of screw entry-points and trajectories in this study had been based on intraoperative imaging obtained by a portable 32-slice CT scanner. This prospective study evaluates feasibility, accuracy, and safety of this novel approach in an initial series of 85 surgeries. METHOD: Medical records and radiological materials of 82 patients who underwent the first 85 consecutive stabilisations were analysed. Incorrect screw position, medical and technical complications as well as availability of this procedure in particular spinal levels were the subject of evaluation. RESULTS: Out of 571 implants inserted in all spinal levels, only five screws (0.87 %) did not meet the criteria for correct implant position. These screw misplacements had not been complicated by neural, vascular or visceral injury and the surgeon was not forced to change the position intraoperatively or during the postoperative period. The quality of intraoperative CT imaging sufficient for navigation was obtained at all spinal segments regardless of a patient's habitus or positioning or comorbidity. CONCLUSION: Intraoperative portable CT scanner-based navigation seems to be an effective way of doing spinal instrumentation guidance. High precision of implant insertion confirms the preconditions of navigation usage during more complex surgeries at any level of the spine.

• MeSH
• bederní obratle chirurgie   MeSH
• design vybavení MeSH
• dospělí MeSH
• fúze páteře přístrojové vybavení   MeSH
• hrudní obratle chirurgie   MeSH
• krční obratle chirurgie   MeSH
• křížová kost chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neuronavigace přístrojové vybavení   MeSH
• pedikulární šrouby * MeSH
• počítačová rentgenová tomografie přístrojové vybavení   MeSH
• prospektivní studie MeSH
• senioři MeSH
• studie proveditelnosti MeSH
• vyšetření u lůžka * MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Transcranial B-mode sonography (TCS) of brain parenchyma is being increasingly used as a diagnostic tool in movement disorders. Compared to other neuroimaging modalities such as magnetic resonance imaging (MRI) and computed tomography, TCS can be performed today with portable machines and has the advantages of noninvasiveness and high resistance to movement artifacts. In distinct brain disorders TCS detects abnormalities that cannot be visualized or can only be visualized with significant effort with other imaging methods. In the field of movement disorders, TCS has been established mainly as a tool for the early and differential diagnosis of Parkinson's disease. The postoperative position control of deep brain stimulation electrodes, especially in the subthalamic nucleus, can reliably and safely be performed with TCS. The present update review summarizes the current methodological standards and defines quality criteria of adequate TCS imaging and assessment of diagnostically relevant deep brain structures such as substantia nigra, brainstem raphe, basal ganglia and ventricles. Finally, an overview is given on recent technological advances including TCS-MRI fusion imaging and upcoming technologies of digitized image analysis aiming at a more investigator-independent assessment of deep brain structures on TCS.

• MeSH
• bazální ganglia diagnostické zobrazování   MeSH
• diferenciální diagnóza MeSH
• echoencefalografie přístrojové vybavení   normy   MeSH
• hluboká mozková stimulace MeSH
• lidé MeSH
• magnetická rezonanční tomografie přístrojové vybavení   normy   MeSH
• multimodální zobrazování normy   MeSH
• nemoci mozku diagnostické zobrazování   terapie   MeSH
• neuronavigace přístrojové vybavení   normy   MeSH
• Parkinsonova nemoc diagnostické zobrazování   terapie   MeSH
• počítačové zpracování obrazu přístrojové vybavení   normy   MeSH
• pohybové poruchy diagnostické zobrazování   terapie   MeSH
• senzitivita a specificita MeSH
• uživatelské rozhraní počítače MeSH
• zajištění kvality zdravotní péče normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

INTRODUCTION: The authors describe the system of spinal navigation based on intraoperative CT imaging and the results of an initial series of patients. MATERIAL AND METHODS: Spinal screws inserted during 50 surgical procedures in the period between November 2012 and October 2013 were evaluated for insertion accuracy, intraoperative complications and the accessibility of the method for the selected spinal level. RESULTS: Out of the total of 295 screws inserted throughout all the spinal levels from C0 to S1, only 4 (1.3%) pedicle screws were found to be incorrectly inserted: a single L5 screw breached the lower cortex of the pedicle, two thoracic pedicular screws penetrated the anterior margin of the vertebral body not exceeding 3 mm of the shaft length, and a single C3 pedicle screw penetrated the upper vertebral body end-plate. None of these complications caused morbidity or required re-operation. Intraoperative CT imaging together with the navigation procedure increased the time of surgery by 30 minutes on average and patient radiation exposure during the initial and accuracy control CT scan was increased. CONCLUSION: Our initial experience has shown that the CT-based computer-assisted spinal navigation system is a precise surgical modality. It enables higher accuracy in spinal screw positioning, resulting in lower surgical morbidity and increased safety for the patient. This benefit should outweigh the longer operation time as well as a higher radiation exposure of the patients.

• MeSH
• chirurgie s pomocí počítače přístrojové vybavení   MeSH
• délka operace MeSH
• dospělí MeSH
• kostní šrouby MeSH
• lidé středního věku MeSH
• lidé MeSH
• neuronavigace přístrojové vybavení   MeSH
• pedikulární šrouby MeSH
• počítačová rentgenová tomografie přístrojové vybavení   MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• chirurgická dekomprese metody   MeSH
• fúze páteře přístrojové vybavení   metody   MeSH
• kostní šrouby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• neuronavigace přístrojové vybavení   MeSH
• počítačová rentgenová tomografie přístrojové vybavení   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH