Placeholder Image

字幕表 動画を再生する

  • - I'm taking a couple of weeks off and while I'm gone,

  • some brilliant people are standing in for me here.

  • First is Alex from Brainbook, he's a brain surgeon.

  • There's nothing gruesome in this video,

  • but there is the answer to a question I never knew I had,

  • how do neurosurgeons find their way around inside the brain?

  • - Neurosurgery is fraught with risk.

  • The brain is packed with almost 100 billion neurons

  • compartmentalised into complex bundles of nerves

  • and other structures that make you who you are.

  • Small parts of your brain are vital for allowing you

  • to speak, move, think, learn and love.

  • As neurosurgeons, we operate in and around

  • these vital structures and spend a great deal of time

  • learning the anatomy so that we can operate safely.

  • The room for error can be millimetres

  • as we manoeuvre around blood vessels and critical nerves

  • and damaging any of these can cause either life changing

  • or life ending complications.

  • No matter how good the surgeon and no matter

  • how good their knowledge, we can still go astray

  • and need a helping hand.

  • Neurosurgery is a specialty that's inherently

  • intertwined with cutting edge technology,

  • and we can use that to guide us

  • when we're navigating the brain.

  • Today I'm going to show you how neurosurgeons

  • can use infrared and electromagnetic image guidance systems

  • to show us exactly where we are in the brain

  • during critical operations like brain tumour surgery,

  • or inserting biopsy needles deep into the brain.

  • This is a Medtronic StealthStation S8.

  • It's a combination of hardware and software

  • that uses special trackable instruments,

  • such as this pointer and this stilette.

  • To be able to guide the neurosurgeon,

  • the system tracks the position of these instruments

  • in relation to the surgical anatomy

  • and sends that information to the software.

  • The software then displays the instrument's position

  • on either the CT or MRI scan of that patient.

  • The system can track instruments either optically

  • using an infrared camera or electromagnetically.

  • With optical tracking, this camera sends out

  • and then detects infrared light

  • that's reflected from these silver balls.

  • The camera then transmits the instrument's location

  • to the navigation software.

  • Similarly, with electromagnetic tracking,

  • the emitter emits a low energy magnetic field

  • with unique characteristics at every point.

  • The electromagnetic instruments contain sensors,

  • which allow the navigation software

  • to identify the instrument's location within the electromagnetic field.

  • For the software to display the instrument's location

  • in relation to images of the patient, you've got

  • to help the software by creating a map

  • between points on the patient and points in the images.

  • This process is called registration,

  • and it's essentially the same for both optical

  • and electromagnetic types.

  • After registration is complete, whenever the surgeon

  • touches a point on the patient using one of these tracked instruments,

  • the computer uses the map

  • to identify the corresponding point on the images.

  • This identification is called navigation.

  • And now I'm going to show you both systems in action.

  • Here we've got an MRI scan of a brain model

  • that we're going to use.

  • Coming up, you see this white blob, which is supposed

  • to be a simulated brain tumour on the MRI scan.

  • Up here, you can see an eye coming into view,

  • and then the nose.

  • So this is the brain that's going to correspond with the model.

  • In the bottom right hand corner, we're using infrared tools,

  • and you can see the pointer coming into reference

  • with the reference array that we've got fixed

  • to the patient's head.

  • We're going to be doing registration as we mentioned before,

  • marking out lots of points with the infrared pointer.

  • Now we can verify the registration.

  • We've got 1.5 millimetre accuracy,

  • which will do for this simulation.

  • So, we're going to touch the tip of the nose on the model

  • and you can see in the MRI that that correlates well.

  • Let's look at the inner part of the eye and that looks good.

  • The outer part of the eye and the tip of the ear,

  • and this is all looking like

  • it's corresponding really nicely.

  • We put the pointer into this hole that's pre made,

  • we're on the tumour, so that's looking good as well.

  • And this is a pre made craniotomy or trapdoor in the skull

  • that's going to allow us to just access the tumour straight away.

  • In real life, we'd make this hole

  • and that would take about 45 minutes to an hour,

  • having cut through the skin and drilled off this bone.

  • So we can operate around this tumour and see exactly

  • where we are in the brain avoiding critical structures

  • like blood vessels, nerves and parts of the brain

  • that are important for speaking and seeing, for example.

  • Now let's move on to the electromagnetic form of navigation,

  • which is also called axiom guidance.

  • We're going to be using a Rowena neurosurgical simulator

  • and thanks a lot to Susie Glover from Delta

  • and Stephanie Brown from NHS Healthcare Horizons.

  • This model is quite cool because it actually has fluid systems within it

  • and here you can see us actually scanning it

  • and we're going to take these CT images and plug them into the software.

  • Here you can see we've put the model in pins,

  • but we don't usually do that because it can interfere

  • with the electromagnetic system.

  • We're going to be using this stilette to guide

  • a piece of tubing deep into the brain's fluid reservoirs.

  • This pointer is what we're going to use to do a registration.

  • This is the actual catheter that we're going to be inserting

  • deep into the brain and we'll take out

  • the little metal stilette that comes with it,

  • and insert the tracked axiom stilette

  • that comes with the electromagnetic system.

  • So now that catheter is tracked, we can use this pointer

  • to mark out exactly what trajectory we're going to be using

  • and see where we're going to need to make a cut

  • and then later on where we're going to make a burr hole

  • which is a small hole in the skull

  • that allows us to access the brain.

  • Now we're going to mark it with a red marker in this case

  • and start drilling.

  • [high speed drilling]

  • Once we've made the hole and done a bit more work

  • in real life, we're ready to put the catheter in.

  • On the right so you can see that the StealthStation

  • is showing us how far we need to go and shows us a target

  • that we've pre-planned.

  • We're going to follow that trajectory

  • and make sure the green dots line up.

  • As we advance the catheter down,

  • it gives us a countdown in millimetres.

  • Once we reach zero, we should be in the ventricle system

  • and as I take out the metal stilette from inside the tubing,

  • fluid should start coming out.

  • And there we are, we are in. And in real life

  • we'd now secure this catheter and get out of there.

  • - Go and subscribe to Brainbook, start with his video

  • on a day in the life of a neurosurgeon on call.

  • Next week, we go from brain surgery to settling on Mars.

- I'm taking a couple of weeks off and while I'm gone,

字幕と単語

ワンタップで英和辞典検索 単語をクリックすると、意味が表示されます

B1 中級

脳神経外科医が脳内をどのようにナビゲートするか (How Neurosurgeons Navigate Inside The Brain)

  • 4 0
    林宜悉 に公開 2021 年 01 月 14 日
動画の中の単語