Digital technology will make description of a surgeon of yesteryear – “Eyes of a Hawk and the Heart of a Lion” obsolete. Familiarity with a mouse will be the order of the day. “Point and Click”, “Single Click, Double Click”, “Left Button, Middle Button and Right Button”, “Drag and Drop” these will be the jargon of the surgeon in the operation theatre.
The last few years have witnessed a tremendous growth in interactive image guided brain surgery – a detailed road map at last. The added advantage is, that this map is updated in real time. The presence of landslides and road blocks ahead are broadcast as in a citizens band radio. Reversing one’s path will almost never take place. How is this done?
Today with real time interactive image guided surgical tool like “The Viewing Wand” it is possible to achieve a navigation as precise as that in the Voyager mission. After all the intricacies and the consequences are none the less initial MRI or CT scanning is done with markers placed on the patients scalp which serve as reference points.
A powerful computer workstation gives a 3D reconstruction of the face. The tumor is always related to the external skin markers. The “Viewing Wand” is a commercially available system consisting of an image processing computer and a mechanical arm, consisting of four movable joints. Each joint consists of a potentiometer that constantly feeds back its position to a personal computer. Thus the computer knows the position in the space, of the end of the arm. Probes of different lengths and shapes can be attached to the end of the arm. This can act as pointer or even as a biopsy forceps.
Using the wand software, the position of recognizable skin features on the patients scalp and skin makers, are registered into the 3D reconstructed image on the powerful computer workstation. After the patient’s head is fixed firmly, the wand is moved around the head. The tip of the wand is always seen on the computer screen relative to the tumor image. The scan data can be reconstructed in the direction that the image is pointing. This allows precise placement of the skin incision. The amount of underlying zone opened will also be less due to precise placement.