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Surgery techniques

Intraoperative MRI

The Intraoperative magnetic resonance imaging (MRI) system at Klink Hirslanden has been specially developed for neurosurgery. Coupled to a computer-assisted navigation system it enables an MRI scan to be done at any point during an operation. This is particularly helpful when operating on certain types of brain tumors – allowing to precisely delineate the margin between tumor and healthy tissue.

Current research suggests that using this technique can improve the outcome for patients. In cases of malignant brain tumors, particularly glioblastomas, we use intraoperative MRI in combination with a fluorescent dye (Gliolan) in order to further optimize the likelihood of a maximal resection.

When operating on pituitary tumors, intraoperative MRI offers a valuable adjunct to endoscope-assisted microsurgery, particularly in order to visualize hidden or difficult-to-access parts of the tumor and assist in its definitive and total removal.

Intraoperative CT

The intraoperative computed tomography (CT) at Klinik Hirslanden is integrated with the “BrainSuite” system – a neurosurgical operating room equipped with

  • the most up-to-date spatial navigation technology and
  • microsurgical instruments

At any point during an operation we can perform a CT scan – this is particularly useful in the area of the skull base, for certain brain tumors, for vascular neurosurgery and for selected spine surgery in order to gain precise spatial orientation.

Using CT intraopertively in this way, the precision and thus the safety of an operation can be significantly improved. In operations for spine stabilization, intraoperative CT provides exact confirmation of the position of prosthetic discs or screws, which may be implanted.

Intraoperative angiography

Our intraoperative angiography system allows us to perform the most advanced vascular neurosurgery for aneurysms and arterio-venous fistulae or malformations. Every angiographically-assisted operation is performed by an experienced, interdisciplary team of neuroradiologists and neurosurgeons.

Using angiographic monitoring, it is possible to measure particular flow parameters in the blood vessels during the operation, facilitating and optimising intraoperative decision-making, like clip selection and positioning.

Intraoperative electrophysiological monitoring

Intraoperative electrophysiological monitoring (neuromonitoring) is used to keep track of important neurological functions while operating. In the brain this is especially important when operating near areas, which process motor functions or vision or near tracks of nerve bundles, which convey electrical signals in the deep brain, brain stem or spinal cord. During spinal surgery, especially in complex cases containing scar tissue or during the placements of implants, electrophysiological monitoring is applied to avoid damage to nerves traveling in and next to the spinal canal.

Depending on the structures and functions to be monitored a variety of methods of monitoring are available and often a combination of techniques is applied (Somatosensory evoked potentials (SSEP), Motor evoked potentials (MEP), Acoustic evoked potentials (AEP), Electroencephalogram (EEG), Visual evoked potentials (VEP) and direct tissue micro-stimulation). In all cases a neurologist is present in the operating room to interpret to electrical impulses while they are obtained. In case of tumour surgery, bi-polar or mono-polar micro probes are used to measure functional activity before and while tumour tissue is removed. Comparable to real-time 3D radar, electrical currents are sent from the tip of the stimulation probe into the surgical field in a spherical fashion and with varying intensities, allowing visualization of distances to eloquent structures in all directions and in real time. Especially at tumour boarders or tumour-infiltrated zones, this allows precise differentiation between tumour and healthy tissue.

Intraoperative MRI - Pole Star in the Hirslanden Clinic
Intraoperative MRI - Pole Star in the Hirslanden Clinic
Intraoperatives CT
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