1. ORL & Maxilo Facial
MAG 2008 Page 1

2. Pourquoi utiliser la navigation en ORL?
· Une resection plus complète des tissus malades (ex: Polype) Le chirurgien peut
etre plus “agressif” avec une navigation
· Un taux de 2nd operation diminué
· Evite les complications chirurgicales
· Augmenter la sécurité et l´efficacité dans le geste
· Extrement utile si un repère anatomique a été enlevé lors d´une chirurgie
précédente
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3. Sommaire
A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Logiciel de navigation per-opératoire
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4. BrainLAB
• 3,000 hopitaux utilisant des logiciels
BrainLAB
• Clients dans plus de 75 pays
• 1000 employés dans 16 bureau de par
le monde
• 230 ingénieurs R&D
• 200 Ingénieurs services
• 3,300 Logiciels installés
• Plus de 350 installations en ORL et CMF
New BrainLAB headquarters in Feldkirchen near Munich
• Nouveau developpement pour la
plannification Maxilo facial depuis 2005
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5. Integrated Neuroscience Center
Etapes de developpement 2008
2007
FiberTracking 2006
Novalis® Tx
Laser-based 2005
surface registration
BrainSUITE® iCT
Integrated radiosurgery 2003
system 2001
1998 BrainSUITE® iMRI
3D visualization
software 1997
Cranial planning &
navigation
1993
1990
Stereotactic radiosurgery
hardware MAG 2008 Page 5

6. Centre de Neuroscience integré
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7. Debloquer les possibilités pour les patients et le staff
Oncologie
Neurochirurgie
Salle op integré
Rachis & Trauma
Orthopédie
Radiologie
Pharmaceutique
ORL
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8. Imagerie Intra-operatoire– 1.5T iMRI
BrainSUITE® iMRI sallle d´opération integré
• Enregistrement automatisé du patient et transfert des scans inter-opératoires.
• Integration de la gestion des données et visualisation permettant d´améliorer le processus
de decision
• Opérations en dehors de la ligne de 5 Gauss utilisant des instruments chirurgicaux
normaux. MAG 2008 Page 8

9. Negatoscope numérique – Digital Lightbox
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10. Sommaire
A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Logiciel de navigation per-opératoire
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11. Technologie a marqueurs passifs
Technique
• Camera envoie des signaux infrarouge
• Les spheres reflechissantes reflechis le signal
• La camera recoit le signal en retour
Votre bénéfice
• Localisation précise de tous les instruments sans erreur
• Pas de d´emmetteur ou recepteur supplémentaire
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12. Platformes
Tous les systèmes utilisent
• Techonolgie avec marqueur passif
• Les memes fonctionalités logicielle
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13. Sommaire
A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Logiciel de navigation per-opératoire
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14. Logiciel de plannification pre-opératoire iPlan
1st step: Frankfort Horizontal
• Landmark based definition of Frankfort
Horizontal and Midsagital Plane in 2D
and 3D.
• Dataset is aligned to defined Planes
• Planes and Alignment necessary to be
able to mirror the segmented objects
from healthy to defect side
Benefit: Fast and easy definition of planes for mirroring and alignment of the
dataset
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15. Logiciel de plannification pre-opératoire iPlan
2nd step: Segmentation of objects
• Several methods of Segmentation:
•Semiautomatic Segmentation
•Segmentation Slice by Slice with
Brush
•Usingof Seed Brush (segments
areas with same Houndfield units)
• Semi-automatic segmentation as
fastest option to segment bony
structures.
Benefit: Several options of segmentation depending on preferences and
indication.
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16. Logiciel de plannification pre-opératoire iPlan
2nd step: Semiautomatic Segmentation
• Segmentation by definition of region of
interest in each view
• Only the red highlighted structures will
be segmented
• Changing of Houndsfield Units until
structures of interested are highlighted
red
Benefit: Most time saving and easiest option of Object Segmentation which
is superior over time consuming standard segmentation slice by slice
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17. Logiciel de plannification pre-opératoire iPlan
3rd step: Mirroring of segmented objects
• Healthy side is used as template for
defect side.
• Object is mirrored at the prior defined
Midsagital plane
Benefit: Time saving creation of templates for reconstruction of defect side
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18. Indication: Movement of fragments
Movement of copied objects
• The copied object can be moved in any
direction
• The movement is done in the 2D views
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19. Résumé de la plannification pre-operatoire
• Semiautomatic Image Fusion – also for
postoperative control
• Definition of Midsagital
• Semiautomatic Segmentation
• Advanced Object Planning (Mirroring)
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20. Particularité BrainLAB: La plannif maxilo faciale
• Frankfort Horizontal alignment brings the patient’s head in a natural position.
• In most cases only one part of the face is affected -so we can use the remaining
as a contour template. => Use of miroring function
• If both sides are affected, the Software can be used as planning tool for
repositioning of big fragments or to plan a model of an implant which can be
exported with a STL –Export (next Version).
• Another major field is implanting of dental. It is possible to plan them with trajectories
and dental implants can be imported and planned via STL-Import (next version)
• With iPlan CMFsurgeons can plan the intervention safe different states and come
back later for refinements.
• Now they can virtually plan the treatment or try out new reconstructive techniques
without touching the patient.
• With the support of an atlas they don‘t need to outline typical structures, iPlan makes
it as easy and fast as possible to generate a treatment template
• With the support of our navigation systems the reconstructions are more precise
and more accurate than before. Now the surgeon can operate in areas where that he
wouldn‘t have touched without the support of BrainLAB‘s advanced technology.
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21. Workflow – 4 étapes pour la navigation per-opératoire
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22. Sommaire
A propos de BrainLAB
Technologie et plateform
Logiciel de plannnification pre-opératoire
Navigation per-opératoire
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23. Navigation per-operatoire
1st step: Preoperative Scan
• Utilization of preoperative scans –
no navigation scan necessary
• No fiducials necessary
Benefit: Reduction of radiation dose for patient
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24. Navigation per-operatoire
2nd step: Intraoperative preparation – Patient reference star
Non-invasive referencing with
headband - generally used for
sinus surgery in ENT
Minimal invasive referencing in
bone structure - generally used
for skull base surgery, lateral
indications or CMF cases
Benefit: Referencing according to needs and
indication.
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25. Navigation per-operatoire
3rd step: intraoperative registration
• Surface scanning with a laser
• No given registration points or registration routes
• Registration accomplished in one minute
• Registration possible in a sterile environment
Benefit: Touchless registration saves sterile environment.
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26. Navigation per-operatoire
4th step: Navigation
Benefit: Time saving setup and workflow as well as advanced functionalities
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27. Navigation per-operatoire
4th step: Instrument integration
• Simple integration of all instruments
• Different geometries of stars and
adapter clamps fit on every
instrument
Benefit: Fast integration of every rigid instrument available in the OR
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28. Navigation per-operatoire
Image integration
Benefit: Video integration endoscope and micorscope as well as image
injection in microscopes
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29. Navigation per-operatoire
Advanced features
Eraser
Intraoperative Imaging
• Virtual anatomical update of structures
Ultrasound integration
• Tip of instrumentintegrated ultrasound
IGSonic as fully is tracked
device
• Removed tissue can be visualized
• virtually
Other imaging devices like C-arms
• First step to real intraoperative imaging
Benefit: From essential navigation to unlimited functionalities
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30. Résumé de la navigation per-opératoire
• Platforms according to needs
• Data acquisition
• Referencing
• Registration
• Navigation and Integration
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31. Conclusion
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32. Conclusion
BrainLAB offre une solution pour la navigation et la plannification ORL
La plannification CMF est une option de la partie ORL
BrainLAB est le seul vendeur majeur proposant une véritable
plannification CMF, prenant en compte les implants
La plannification et la plateforme de navigation sont concues
pour recevoir d´autres spécialités (Neuro, ortho, Etc.)
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33. …merci!
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