Brainlab

Introduction: Stereotactic radiosurgery (SRS) has been increasingly advocated for 1-3 small brain metastases. The goal of this study was to evaluate the clinical results in patients with brain metastases treated with LINAC-based SRS using a thermoplastic mask (non-invasive fixation system) and Image-Guided Radiotherapy (IGRT). Material and Methods: In this single-institution study 48 patients with 77 brain metastases were treated between February 2012 and January 2014...

PURPOSE: The aim of this study was to investigate the intra-fractional patient motion using the ExacTrac system in LINAC-based stereotactic radiosurgery (SRS). METHOD: A retrospective analysis of 104 SRS patients with kilovoltage image-guided setup (Brainlab ExacTrac) data was performed. Each patient was imaged pre-treatment, and at two time points during treatment (1st and 2nd mid-treatment), and bony anatomy of the skull was used to establish setup error at each time point...

PURPOSE: The aim of this study was to develop Quality Assurance procedures for the BrainLab ExacTrac (ET) imaging system following the TG 142 recommendations for planar kV imaging systems. MATERIALS AND METHODS: A custom-designed 3D printed holder was used to position the Standard Imaging QCkV-1 phantom at isocenter, facing the ET X ray tubes. The linac's light field (collimator at 45⁰) was used to position the phantom holder. The ET images were exported to ARIA where geometric distortion was checked...

This paper examines the difference in patient specific dosimetry using three different detectors of varying active volume, density and composition, for quality assurance of stereotactic treatments. A PTW 60017 unshielded electron diode, an Exradin W1 scintillator, and a PTW 31014 PinPoint small volume ionisation chamber were setup in a Lucy 3D QA phantom, and were positioned at the isocentre of an Elekta Axesse, with beam modulator collimator, using Exactrac and a HexaPODTM couch. Dose measurements were acquired for 43 stereotactic arcs, and compared to BrainLAB iPlan version 3...

Stereotactic body radiotherapy (SBRT) for spine tumors has demonstrated clinical effectiveness. The treatment planning and delivery techniques have evolved from dynamic conformal arc therapy, to fixed gantry angle intensity modulated radiotherapy (IMRT), and most recently to volumetric modulated arc therapy (VMAT). A hybrid-arc (HARC) planning and delivery method combining dynamic conformal arc therapy delivery with a number of equally spaced IMRT beams is proposed. In this study we investigated plan quality, delivery accuracy, and efficiency of 3 delivery techniques: IMRT, HARC, and VMAT...

BACKGROUND: A stereotactically placed laser fiber can deliver thermal energy to an epileptogenic focus in brain. This procedure is done under intraoperative (thermography) magnetic resonance imaging (MRI) guidance. Thermoablation can lead to edema in surrounding area and can cause secondary insult. In this case report of three cases, we have quantified the edema produced after laser ablation, with sequential MRI in immediate post-operative period. CASE DESCRIPTION(S): Three patients of intractable epilepsy underwent proper neurological and neuro-radiological workup to localize the site of epileptogenic foci...

Background: Colloid cysts are rare benign lesions with potentially devastating results. Complications intra and posttreatment can result in high rates of recurrence. Stereotactic radiosurgery may present an attractive option for decreasing the rate of recurrence in conjunction with stereotactic aspiration. Case Description: Here, we report four cases of colloid cyst of the third ventricle managed by stereotactic aspiration with the use of the Leksell frame followed by stereotactic radiosurgery with the BrainLab/Novalis linear accelerator...

Computer-assisted navigation techniques are used to optimise component placement and alignment in total hip replacement. It has developed in the last 10 years but despite its advantages only 0.3% of all total hip replacements in England and Wales are done using computer navigation. One of the reasons for this is that computer-assisted technology increases operative time. A new method of pelvic registration has been developed without the need to register the anterior pelvic plane (BrainLab hip 6.0) which has shown to improve the accuracy of THR...

PURPOSE: The aim of this work is to determine experimentally the correction factors [Formula: see text] for four active commercial dosimeters: two microchambers and two diode detectors based on the output factor measured with radiochromic film for a radiotherapy linear accelerator equipped with circular cones. MATERIALS AND METHODS: Initially, a radiochromic film dosimetry measurement protocol with an accuracy of 2% was developed to approach the "reference output factor"...

BACKGROUND: Intraoperative navigated ultrasonography has reached clinical acceptance, while published data for the accuracy of some systems are missing. We technically quantified and optimised the accuracy of the integration of an external ultrasonography system into a BrainLab navigation system. METHODS: A high-end ultrasonography system (Elegra; Siemens, Erlangen, Germany) was linked to a navigation system (Vector Vision; BrainLab, Munich, Germany). In vitro accuracy and precision was calculated from differences between a real world target (high-precision crosshair phantom) and the ultrasonography image of this target in the navigation coordinate system...

PURPOSE: To evaluate the dosimetric impact of uncorrected rotations on the planning target volume (PTV) coverage for early stage non-small cell lung cancer patients treated with stereotactic body radiotherapy using Brainlab ExacTrac image guidance. METHODS: Twenty-two patients were retrospectively selected. Two scenarios of uncorrected rotations were simulated with magnitude of 1°, 2°, 3° and 5°: (1) rotation around the treatment isocenter; and (2) roll and yaw rotations around a setup isocenter...

OBJECTIVE: Stereotactic procedures are performed in many neurosurgical departments in order to obtain tumor tissue from brain lesions for histopathological evaluation. Biopsies can be performed frame-guided and frame less. Some departments use a biopsy needle (cylinder probe), others a forceps for repetitive smaller tissue samples. Although the applied techniques are somehow different, it is still unclear how many tissue samples have to be taken to establish reliably a final diagnosis based on histopathological and genetic examinations...

BACKGROUND AND IMPORTANCE: Stereotactic biopsies or needle aspirations of posterior fossa lesions are technically challenging. Here we report a novel technique for performing these procedures employing the Airo™ intraoperative computed tomographic (CT) scanner and the VarioGuide™ articulated arm (BrainLab, Munich, Germany). CLINICAL PRESENTATION: A 62-yr-old woman presented with an irregularly shaped, enhancing lesion of the left pons/middle cerebellar peduncle...

BACKGROUND: Electrode placement in epilepsy surgery seeks to locate the sites of ictal onset and early propagation. An invasive diagnostic procedure, stereoelectroencephalography (SEEG) is usually implemented with frame-based methods that can be especially problematic in young children. OBJECTIVE: To evaluate the feasibility and accuracy of a new technique for frameless SEEG in children using the VarioGuide® system (Brainlab AG, München, Germany). METHODS: A frameless stereotactic navigation system was used to implant depth electrodes with percutaneous drilling and bolt insertion in pediatric patients with medically refractory epilepsy...

BACKGROUND AND IMPORTANCE: In contrast to cranial interventions, neuronavigation in spinal surgery is used in few applications, not tapping into its full technological potential. We have developed a method to preoperatively create virtual resection planes and volumes for spinal osteotomies and export 3-D operation plans to a navigation system controlling intraoperative visualization using a surgical microscope's head-up display. The method was developed using a Sawbone ® model of the lumbar spine, demonstrating feasibility with high precision...

OBJECTIVE: To determine if the laterality of primary tumors in patients with olfactory neuroblastoma (ONB) influenced the pattern and development of neck disease. METHODS: Using a retrospective cohort study design from 1994 to 2015, the primary tumors of patients who either presented with or developed neck disease were volumetrically analyzed using iPlan software (version 3.0.0, BrainLAB, Feldkirchen, Germany) by two independent observers. Agreement of volume-derived sidedness was assessed with a kappa statistic, whereas agreement in volume-derived degree of tumor laterality was evaluated with an intraclass correlation coefficient...

OBJECTIVE: To evaluate efficacy and reliability of intraoperative Doppler sonography in localizing the transverse and sigmoid sinuses during lateral suboccipital craniotomy. METHODS: A 16-Mhz intraoperative micro-Doppler ultrasound (16Mhz, Multi-Dop pro, Compumedics, Singen, Germany) was applied to detect the medial border of the sigmoid sinus and the inferior border of the transverse sinus in 25 patients. Micro-Doppler measurements were compared with magnetic resonance- and computed tomography-based image guidance (Kolibri, Brainlab, Munich, Germany)...

INTRODUCTION: Radiosurgery is now an established method of satisfactory pain control in patients with trigeminal neuralgia (TN). The Varian Truebeam STx (Varian Medical Systems, Palo Alto, CA) linear accelerator (LINAC) system is an arc-based, frameless stereotactic radiosurgery system used for the treatment of TN. To our knowledge, there has been only one published series of patient histories that documents the use of a frameless LINAC system for the treatment of TN. We describe the treatment parameters, patient outcomes, and complications associated with the treatment of TN...

OBJECTIVE: The course of malignant brain stem gliomas in childhood is rarely positive. Because of limited therapeutic options and potentially hazardous biopsies oncologist often relay on MRI diagnoses only for further therapy decisions. In this study we show that brain stem biopsies display a low morbidity rate and neuropathological assessment has a considerable impact on further treatment decision. METHODS: Within 18-months five children with brainstem symptoms and the radiological diagnosis of a malignant brainstem glioma, were identified...

BACKGROUND: A drawback of conventional neuronavigation is the necessity of focusing on two-dimensional images in 3 planes at the same time to determine one's position in the operating field. A solution would be to merge the images into a single three-dimensional (3D) image that mirrors the actual anatomy. The introduction of holographic glassless 3D monitors paved the way to 3D navigation. We present our experience with 3D neuronavigation as exemplified by navigation to and within the sella...