Surgical planning is the preoperative method of pre-visualising a surgical intervention, in order to predefine the surgical steps and furthermore the
bone segment navigation in the context of
computer-assisted surgery.
The surgical planning is most important in
neurosurgery
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and ...
and
oral and maxillofacial surgery. The transfer of the surgical planning to the patient is generally made using a
medical navigation system.
__TOC__
Principles of surgical planning
The imagistic
dataset A data set (or dataset) is a collection of data. In the case of tabular data, a data set corresponds to one or more database tables, where every column of a table represents a particular variable, and each row corresponds to a given record of the d ...
used for surgical planning is mainly based on a
CT or
MRI. In
oral and maxillofacial surgery, a different, more "traditional" surgical planning can be used for
orthognatic surgery, based on cast models fixed into an
articulator.
History of the concept
In order to make a surgical planning, one would need a
3D image of the patient. The starting point was made by
G. Hounsfield in the 1970s, by using
CT in order to record data about the anatomical situation of the patients. In the 1980s, advances were made by the radiologist
M. Vannier and his team, by creating the first computed three-dimensional reconstruction from a
CT dataset. In the early 1990s, the surgical planning was performed by using
stereolithographic models. During the late 1990s, the first
full computer-based virtual surgical planning was made for
osteotomies, and then transferred to the operating theatre by a
navigation system A navigation system is a computing system that aids in navigation. Navigation systems may be entirely on board the vehicle or vessel that the system is controlling (for example, on the ship's bridge) or located elsewhere, making use of radio or othe ...
. Currently 3D Printed models are also used to plan a procedure and improve patient outcomes.
The first commercially available neurosurgical planning systems appeared in the 1990s (the StealthStation by
Medtronic
Medtronic plc is an American medical device company. The company's operational and executive headquarters are in Minneapolis, Minnesota, and its legal headquarters are in Ireland due to its acquisition of Irish-based Covidien in 2015. While it ...
, the VectorVision by
Brainlab). As newer imaging modalities emerged providing increasing anatomical and functional detail for the patient in the 2000s, these surgical planning systems started to incorporate
virtual reality
Virtual reality (VR) is a simulated experience that employs pose tracking and 3D near-eye displays to give the user an immersive feel of a virtual world. Applications of virtual reality include entertainment (particularly video games), e ...
technology to facilitate the visualisation and manipulation of the 3D data. One example of such systems is the
Dextroscope, manufactured by
Volume Interactions Pte Ltd. The Dextroscope is mostly used in the planning of complex neurosurgical procedures.
[{{cite journal , author = Robison R. A., Liu C. Y., Apuzzo M. L. J. , year = 2011 , title = Man, Mind, and Machine: The Past and Future of Virtual Reality Simulation in Neurologic Surgery , journal = World Neurosurgery , volume = 76 , issue = 5, pages = 419–30 , doi=10.1016/j.wneu.2011.07.008 , pmid=22152571]
References
Oral and maxillofacial surgery
Health informatics
Radiology
Tomography
Computer-assisted surgery