Novel Head Frame for Whole Brain MRI Real-Time Neuronavigation for Neurosurgery Presenter: Francesco T Mangano DO FACS (Chief, Pediatric Neurosurgery) Matthew Batie CLES BMET BS (CE-Specialist)

Problem Novel MRI Compatible Head Frame Neurosurgeons have struggled with exact localization and treatment of brain pathology even in the modern era MR guided stereotactic procedures currently allow for single trajectories for placement of brain stimulators, electrodes, ablations or biopsies Multiple trajectories would entail significant additional time and morbidity for the patient- the procedure would no longer be minimally invasive Can we develop a new way to achieve multiple exact (as many as 18, mean=12) trajectories to manage old and emerging treatments in pediatric and adult neurosurgery?

Novel MRI Compatible Head Frame Current Practice: We cannot easily make more than 1 trajectory in an MRI environment for neurosurgical treatment Clearpoint Frame The Job Job: Creation of an instrument that will allow for minimally invasive multiple exact trajectories, unilaterally or bilaterally, in an MRI environment. Incorporation of augmented reality into this environment would create a further safety net for surgical planning.

Additional needs Novel MRI Compatible Head Frame Augmented Reality platform: visualization of minimally invasive brain anatomy Tool and implant(s) projected and displayed in 3D intracranial space May be a gateway to further significant advances in neurosurgery-MRI environment

Advantages: Other Environments Novel MRI Compatible Head Frame Frame can be used in combination with stereotactic technology in the traditional operating room with additional AR capability for minimally invasive navigation. Stereotactic technology and tool recognition with appropriate AR technology for augmented navigation would increase efficiency and safety in this environment as well

Constraints All development must be MRI compatible Novel MRI Compatible Head Frame All development must be MRI compatible Accurate stereotactic fusion of images and navigation Multiple technologies must be incorporated and working in unison Streamlining graphical AR interface

Summary Novel MRI Compatible Head Frame The field of neurosurgery continuously strives to become less invasive while providing better outcomes safely. The development of this technology would provide: 1. A new environment to further advance the field in Pediatric and Adult NS 2. A novel head frame to open the door to further procedures in an MR-OR 3. Combine real-time Clinical Care and Augmented Reality for the first time The clamp pictured is the Mayfield Clamp developed by Frank Mayfield MD (1908-1991) in 1973. This clamp is used thousands of times in the operating room every day in every corner of the world and it revolutionized neurosurgery since its invention Our new type of head frame may open another venue in the world of clinical neurosurgery- the Stereotactic Augmented Reality MR based operating suite.