MICROSCOPY & IMAGING
surgical microscopes are paving the way for new surgical operating approaches. Not only does the ARveo deliver excellent resolution, depth-of-fi eld and colour on ultra-high-defi nition 4K screens, the 3D depth perception is also comparable with that achieved with binocular microscopes. T is enables neurosurgeons to determine tissue characteristics, discern subtle changes and confi dently manoeuvre their surgical instruments in and out of deep cavities. T is gives the surgeon confi dence in what he or she is assessing and reduces their physical strain and tiredness, allowing them to perform long surgeries in a more comfortable operating position. Particularly in conjunction with exoscopic surgery, neurosurgeons can now orient the microscope into any fi eld at any angle, allowing the surgeon to stand or sit upright, look straight ahead and move only their hands rather than their entire body in the direction of work, throughout the operation. T is technology may even open up
new or rarely used angles compared with conventional optical microscopy. For example, surgery performed in the posterior fossa, with a supracerebellar infratentorial approach to the pineal region to biopsy or resect pineal-region tumours, can traditionally be performed in either a prone or semi-sitting position. T e semi-sitting position involves bending the neck to look upwards at the surgical site and raising the arms in an overhead position for long periods of time during
The ARveo digital microscope is being embraced by neurosurgeons
the surgery. However, performing the same type of surgery using an exoscope with heads-up display avoids the unnecessary tiring of the neck and arms, while providing a caudal-to-cranial view of the patient and surgical site. Surgeons now have the advantage of being able to adapt the microscope image instantly, rather than their bodies to be able to visualise what they need to see in the surgical fi eld of view.
AUGMENTING REALITY FOR INTEGRATED INSIGHTS As a digital operating microscope, the information provided by the ARveo can be integrated with data from other devices and sources, for example, real- time information on the patient’s vitals. Connectivity can also be leveraged to integrate image guided surgery (IGS) and AR image overlays. For example, IGS with AR can reveal both the cortical surface as well as an in-depth view of a tumour. Another example is the intraoperative fl uorescence imaging of tumours, using the active substance, 5 aminolevulinic acid (5-ALA) and the blue light fl uorescence module, Leica FL400.5 “When we talk about fl uorescence imaging, intraoperative fl uorescent angiography, intraoperative fl uorescence for a tumour surgery with 5-ALA, I think the resolution and the perception of the fl uorescence on the big screen is actually a little bit better than when it’s injected into the ocular,” says Guzman.
Moreover, fl uorescent AR from the
Glow platform can provide additional precise, real-time information that can prove critical for timely decision- making in the operating room. T e latest Glow800 augmented reality fl uorescence delivers impressive fl uorescent visualisation both on-screen for heads-up neurovascular surgery and in the binocular view, via the CaptiView image injection module. T e fl uorescent signal appears to be truly within the blood vessel and not fl oating above or beside it, which is important as it allows surgeons to move the blood vessels to see what is behind them – a view that may previously been obstructed by a surgical clip, for example. Given the ever-improving image
quality available with digital microscopes and heads-up displays, there is a growing trend towards using this more comfortable, convenient and precise imaging technology in neurosurgery and neurovascular surgery. As these and other innovations continue to proliferate in the surgical fi eld, it is hoped that surgical interventions for brain and other tumours can continue to improve, both in terms of operative ease and eff ectiveness for surgical teams and in terms of clinical outcomes for patients.
Dr Robert Ibe is with Leica Microsystems
www.leica-microsystems.com
www.scientistlive.com 47
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