The Future

In speculating about the future for image-guided neurosurgical interventions, it is interesting to consider whether registration of pre-operative images to the patient will still be important. The advent of interventional MRI has led some to suggest that the quality of intraoperative imaging will provide all the necessary information to carry out a surgical procedure. Visualization and interaction with this data is an important issue, however.

Incorporation of a navigational device into an interventional scanner is important. The surgeon wants to see the location of a pointer or surgical tool in the images without needing to re-scan with the tool in place. This flexibility will enable scans to be performed only when there is significant movement or tissue deformation.

Also, as the scope of intraoperative imaging widens, so does that of pre-operative imaging. There will be more accurate and more functional data available from pre-operative scans that may not be practical to obtain during a procedure. Ideally, the segmentation of relevant features will be done automatically in real time. This process may be more practically achieved by alignment with previously segmented images.

The challenge for future navigation systems will be to incorporate pre-operative and intraoperative data seamlessly into the neuro-surgical process, with real time update of the pre-operative model to compensate for both rigid and non-rigid movement of the patient. The relevant features will be visualised by the surgeon without complicated interaction and ideally directly on the operative view of the patient. Advances in imaging, tracking, computational power, algorithms, perception and display devices will be required. Significant research effort is being directed towards all these areas and will hopefully make this a reality.

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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