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NOVEL HEAD FRAME FOR WHOLE BRAIN MRI REAL-TIME NEURONAVIGATION FOR NEUROSURGERY Presenter: Francesco T 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 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 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: 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 Additional needs Novel MRI Compatible Head Frame • Augmented Reality platform: visualization of minimally invasive brain anatomy • Tool and implant(s) projected and displayed in 3 D 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 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 Novel MRI Compatible Head Frame • All development must be MRI compatible • Constraints 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 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