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.

Solution Novel MRI Compatible Head Frame The Solution: 1. Frame locks the head in the desired position 2. MRI image is obtained and automatically fused to stereotactic platform 3. Surgeon picks entry points and targets 4. Notification of alignment of entry point and target when appropriate trajectory is reached- graphically overlaid augmented reality 5. Trajectory is locked on guide and procedure performed. 6. Surgeon moves to next target.

Advantages Creation of new capabilities and processes: Novel MRI Compatible Head Frame Creation of new capabilities and processes: Whole procedure completed in MRI: real-time Patient does not move: stays in same position until the case is done- safe, efficient Decreased planning and case time Multiple entry sites with minimal position adjustments with one initial frame mount Safety: complication identification is immediate