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Frank Bova, PhD One of the basic tenets of Neurosurgical planning is the ability to generate an operative approach that minimizes the disruption of normal tissue while allowing the required exposure of target tissue. Over the past decades image guided surgical systems have develop stereotactic tools to allow guidance of neurosurgical applications such as craniotomy, biopsy, VP shunts, deep brain stimulation, radiosurgery as well as the implantation of spine instrumentation. The application of this technology requires costly and cumbersome equipments to be present in the operative room during the surgical procedure and often requires the manipulation of images from both within and outside the sterile field. In order to reduce the cost of the required equipment, size of the equipment present in the OR, and personnel required for assistance during the operative procedure, we have developed a new guidance methodology based on rapid prototyping technology. This new approach begins with the design and fabrication of custom stereotactic frames based upon routinely obtained Computed Tomographic or Magnetic Resonance Image scans. Software has been developed, using the VTK tool kit, to create a virtual patient surface from CT or MR scans and to fabricate a custom mask, ones that precisely and unambiguously fits the patient's facial anatomy. This mask is used to register the real world patient and the rapid prototyped real world tools to the virtual patient and the virtual plan. The system has the ability to fabricate various trajectory guides and to fabricate craniotomy guides. For the craniotomy guide the surgeon's describes a bone flap and the system designed and fabricates a location specific plunge guide, one that allows the surgeon to precisely remove the underlying thickness of the skull, preventing the drill from penetrating to the dural surface. To assist in the quality assurance of the process a stereotactic phantom has been adapted to allow the fabricated guides to be tested with patient specific target coordinates prior to surgical use. Two types of fabrication technology have been studied. 1) Three-dimensional (3D) printing, a process that builds the object by adding layer of material on top of one another. 2) Subtractive rapid-prototyping technology, a technology that carves the final object from a block of material. Three series of test have been conducted. The first was an IRB non-significant risk clinical trial that allowed these new guidance devices to be judge against a commercially available image guidance workstation. The second was a series of mock procedures on volunteers targeting multiple intracranial targets, again judged against the trajectories presented by a commercial image guidance workstation. And finally a test of the plunge guides for craniotomy on model skulls. These tests indicate that accuracies and precision are indistinguishable from current commercial systems and within clinically acceptable guidelines. Biosketch Frank J. Bova received his bachelors and masters in Biomedical Engineering from Rensselaer Polytechnic Institute in 1972 and 1973 respectively, and was awarded a Ph.D. in Nuclear and Radiological Engineering from the University of Florida in 1977. He has been on faculty at UF, in the College of Medicine, for 30 years. Dr. Bova holds the academic rank of Professor of Neurosurgery and is the AE and BW Einstein Professor of Computer Assisted and Image Guided Neurosurgery. He is a Fellow of the American College of Radiology, a Fellow of the American Institute of Physics in Medicine and a Fellow of the American Institute of Medical and Biomedical Engineering. Dr. Bova directs the Radiosurgery/Biology Laboratory at the University of Florida McKnight Brain Institute. His areas of interest include radiosurgery and image guided surgery. |