Now surgeons can see scans through a microscope

Vivek Deshmukh, M.D., FACS
Medical director, Providence Neurointerventional Services

Published May 2012

It’s well known that the vast majority of neurosurgeons rely on MRI, CT or catheter angiography when planning and performing a procedure. These images, combined with a high-powered surgical microscope, help the surgeon to determine the precise location of the lesion as well as its size and morphology.

But even this sophisticated combined technology has its limits. The draped and sterile microscope sits within the surgical field, while the radiographic images are typically housed at a computer workstation elsewhere in the operating room. Should the surgeon uncover an unexpected anatomy or unknown pathology, he or she must leave the sterile field while still in surgical garb to review the relevant images at the computer workstation.

Not only does this interruption add time and inconvenience to the surgical case, it risks contaminating the sterile field.

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Neurointerventional Services

9155 SW Barnes Road, Suite 440
Portland, OR 97225

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call 503-297-3766

Providence Brain and Spine Institute has developed a seamless way to review radiographic images in the operating room. Through the use of a converter and one additional cable, images from the radiology workstation can be streamed directly into the surgical microscope ocular by a member of the hospital IT team.

When the need arises, the surgeon can view these images directly through the microscope with the push of a button. When the imaging review is complete, the same button returns to the microscope’s surgical view.

The ability to toggle between two images – the live microscope view and the instantly accessible pre-op angiogram or scan – already has shown its value at Providence St. Vincent Medical Center.

Pre-op imaging shows
the aneurysm.
Surgery reveals an unexpected clotted lobule.
On second look
mid-procedure, the pre-op image confirms the lobule.

In one case, a 64-year-old woman presented with an incidentally discovered brain aneurysm. Because of its location and configuration, it could not be repaired through endovascular embolization. Instead, the patient needed to undergo a craniotomy so the aneurysm could be clipped surgically.

During the procedure, a secondary problem appeared – a partially clotted lobule not obvious when the images were viewed before the surgery. When the pre-op image was called up through the microscope view, however, the clotted lobule was clearly evident, which provided the surgeon with instant confirmation. He did not have to interrupt the procedure or disturb the sterile field to review the images at a separate station. Both aneurysm and lobule were repaired without difficulty.

In another aneurysm repair, which required the vessels to be injected with a contrast dye, the surgeon was able to use the angiogram as an anatomical guide, switching back and forth between live view and image to ensure that the right vessel was sacrificed.

This novel technique, called “microscope integrated radiology,” saves time, lowers infection risk and improves surgical workflow. It has the potential for use across neurosurgical disciplines, including spine, tumor and neurovascular. Microscope integrated radiology was first developed and used at Providence St. Vincent Medical Center and was presented at the American Association of Neurological Surgeons meeting in April.

Clinical articles by Vivek Deshmukh, M.D.