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R J Bale

Publications and source records attributed to R J Bale.

17 recordsLinked to original sources
PubMed2002

[Computer-assisted drilling of the lower extremity. Technique and indications].

Computer assisted navigation-based surgery is a novel and interesting challenge for todays surgeons. One must however keep in mind, that the indications for these techniques (a) should be carefully considered, (b) used only if morbidity is not increased and (c) when previously problematic or inacurate surgical methods can be improved upon. This study reports that, using a non-invasive fixation method (FISCOFIX-Cast), lesions between the ankle- and knee-joints can be precisely localized, registered and treated. Due to the difficult access to lesions especially in the posterior areas of the talus, using conventional arthroscopic methods this procedure is very useful. Percutaneous retrograde drilling (cf. [6, 7, 9, 15, 20, 21]) spared the joint's cartilage in all cases. At the level of the knee joint we see the usefulness of this method for complex situations (cf. [12, 13]) requiring precise drilling.

Anterior Cruciate Ligament↗
PubMed2001

[Computer-assisted retrograde drilling of osteochondral lesions of the talus].

Treatment principles of osteochondral lesions of the talus usually consist of debridement of the chondral part and methods that attempt to stimulate revascularization of the necrotic bony part of the lesion. The latter is mostly achieved through multiple drilling of the subchondral zone. Dorsomedial talar dome lesions are frequently inaccessible with antegrade drilling techniques. In addition, if the cartilage surface over the bony lesion is still intact, it can be injured by antegrade drilling. To overcome these potential problems, retrograde drilling techniques have been developed using drill guides or intraoperative fluoroscopy. Our proposed method of computer-assisted retrograde drilling is an advancement of these techniques. The use of 3D navigation provides the possibility for placing a guide wire exactly in the center of the lesion defined on preoperative MRI or CT scans. This guide wire can then be overreamed with cannulated reamers followed by retrograde bone grafting of the lesion or allows multiple retrograde drilling of the subchondral plate using a parallel drill guide. We found that computer-assisted retrograde drilling could improve precision, avoid misplacement of guide wires, and reduce the time of surgery and intraoperative fluoroscopy.

Arthroscopy↗
PubMed2000

Head and neck tumors: fractionated frameless stereotactic interstitial brachytherapy-initial experience.

The authors used a frameless stereotactic navigation system, the Vogele-Bale-Hohner head holder, and a targeting device to reproducibly position brachytherapy needles for fractionated interstitial brachytherapy in 12 patients with inoperable cancers of the head and neck. In all cases, deviations of the needle relative to the planned position were within 1-15 mm depending on the location of the tumor.

Brachytherapy↗
PubMed2000

Treatment of Stanford type B aortic dissection with stent-grafts: preliminary results.

PURPOSE: To evaluate the feasibility and safety of endovascular stent-graft placement in treating Stanford type B aortic dissection. MATERIALS AND METHODS: Seven patients underwent endovascular stent-graft placement for type B aortic dissection. Five patients had acute and two had chronic dissection. In five patients, the proximal entry tear was within 2 cm of the origin of the left subclavian artery, and in two patients it was beyond this site. In three patients, the noncovered proximal portion of the stent-graft was placed across the origin of the left subclavian artery. The efficacy of the procedure was assessed at follow-up studies 3, 6, 12, and 24 months after intervention. RESULTS: The procedure was technically and clinically successful in six patients (86%). The left subclavian artery remained patent in all patients. In two patients with involvement of aortic branches, endovascular stent-graft placement restored adequate blood flow to the compromised branches. One patient was readmitted 1 month later because the dissection extended into the ascending aorta. In all but this patient, closure of the entry tear and thrombosis of the false lumen along the stent-graft were achieved. All false lumina shrank considerably. The mean follow-up time was 14 months (range, 1-25 months). CONCLUSION: Type B aortic dissections within and beyond 2 cm of the origin of the left subclavian artery can be treated safely and effectively by means of endovascular stent-graft placement.

Adult↗
PubMed2000

Computer-assisted neurosurgery by using a noninvasive vacuum-affixed dental cast that acts as a reference base: another step toward a unified approach in the treatment of brain tumors.

OBJECT: The purpose of the study was to evaluate the use of the Vogele-Bale-Hohner (VBH) mouthpiece, which is attached to the patient's upper jaw by negative pressure, for patient-image registration and for tracking the patient's head during image-guided neurosurgery. METHODS: A dynamic reference frame (DRF) is reproducibly mounted on the mouthpiece. Reference points, optimally distributed and attached to the mouthpiece, are used for registration in the patient's absence on the day before surgery. In the operating room, the mouthpiece and DRF are precisely repositioned using a vacuum, and the patient's anatomical structures are automatically registered to corresponding ones on the image. Experimental studies and clinical experiences in 10 patients confirmed repeated (rigid body) localization accuracy in the range of 0 to 2 mm, throughout the entire surgery despite movements by the patient. CONCLUSIONS: Because of its noninvasive, rigid, reliable, and reproducible connection to the patient's head, the VBH vacuum-affixed mouthpiece grants the registration device an accuracy comparable to invasive fiducial markers.

Adult↗
PubMed1999

Computer-aided surgery in the petrous bone.

OBJECTIVE: We demonstrate that computer-assisted frameless stereotactic navigation with the ISG/ELEKTA Viewing Wand system in the petrous bone is routinely possible with sufficient application accuracy. METHODS: High-resolution computed tomography imaging is done with a dedicated structure attached to the mouthpiece of the Vogele-Bale-Hohner (VBH) head holder, an integral part of our intraoperative patient fixation. The patient image registration can be reliably performed before surgery in an unsterile environment with the registration structure of the mouthpiece. For intraoperative navigation either the position-sensitive articulated arm or the optical three-dimensional digitizer of the ISG/ELEKTA system is used. RESULTS: In the operations of the petrous bone performed so far, i.e., mastoidectomy, cholesteatoma surgery, and lateral skull base revision surgery, the clinical value of three-dimensional navigation was clearly demonstrated with an application accuracy, constant throughout surgery, mostly limited only by the resolution of the computed tomography.

Cholesteatoma, Middle Ear↗
PubMed1998

[Noninvasive head fixation for external irradiation of tumors of the head-neck area].

PURPOSE: To fully utilize the technical capabilities of radiation diagnostics and planning, a precise and reproducible method of head fixation is a prerequisite. METHOD: We have adapted the Vogele-Bale-Hohner (VBH) head holder (Wellhöfer Dosimetrie, Schwarzenbruck, Germany), originally designed for frameless stereotactic operations, to the requirements of external beam radiotherapy. A precise and reproducible head fixation is attained by an individualized vacuum upper-dental cast which is connected over 2 hydraulic arms to an adjustable head- and rigid base-plate. Radiation field and patient alignment lasers are marked on a relocatable clear PVC localization box. RESULTS: The possibility of craniocaudal adjustment of the head plate on the base plate allows the system to adapt to the actual position of the patient on the radiotherapy couch granting tensionless repositioning. The VBH head holder has proven itself to be a precise yet practicable method of head fixation. Duration of mouthpiece production and daily repositioning is comparable to that of the thermoplastic mask. CONCLUSION: The new head holder is in routine use at our hospital and quite suitable for external beam radiation of patients with tumors of the head and neck.

Equipment Design↗
PubMed1998

[First experiences with computer-assisted frameless stereotactic interstitial brachytherapy (CASIB)].

PURPOSE: To reach an optimal treatment result and to avoid damage to critical structures a homogeneous dose distribution in the tumor volume with a rapid decreasing dose to the surrounding structures is necessary. Fractionated interstitial brachytherapy of tumors in the ENT region employing needles depends on exact localization of the target volume during all fractions. Therefore reproducibility of positioning of the needle(s) plays an important role. MATERIAL AND METHODS: We used the ISG Viewing Wand system in combination with the Vogele-Bale-Hohner (VBH) head holder and a new targeting device. Point of entrance, pathway, and target point of the needle were planned and insertion of the needle simulated in advance. To date we have treated 7 patients with inoperable tumors in the ENT region. The actual position of the needle in the control CT was compared to the planned position. RESULTS: The accuracy of positioning of the needle depended on the location of the tumor. In a patient with a recurrent retroorbital adenocarcinoma the mean accuracy was 1 mm. Due to soft tissue displacement in the neck region and the resulting necessity to readjust the targeting device the needle was placed with a mean deviation of 15 mm between the planned and the actual position. CONCLUSIONS: Computer-assisted frameless stereotactic interstitial brachytherapy allows for precise, reproducible and preplanned insertion of hollow needles into target structures closely adherent to the surrounding tissue, thus avoiding damage of neighbouring structures. This technique is of great advantage in treating deeply seated tumors which are fixed to bony structures, especially at the skull base. Inaccuracy in the neck region caused by soft tissue shift requires improvement of the immobilization in this region.

Brachytherapy↗
PubMed1997

VBH head holder to improve frameless stereotactic brachytherapy of cranial tumors.

Precise target localization is essential for brachytherapy. We have adapted the VBH (Vogele-Bale-Hohner) head holder (Wellhoefer Dosimetry, Schwarzenbruck, Germany), originally developed at the University of Innsbruck, for frameless stereotactic surgery, for use in brachytherapy of cranial tumors. The VBH head holder allows for rigid, noninvasive head fixation by means of an individualized upper dental cast. Registration rods, rigidly attached to the dental cast, provide stable external points of reference. The dental cast is sucked against the upper palate by vacuum, and then the fixated patient is scanned. During simulation, the targeting device can be positioned with respect to the virtual patient using the ISG Viewing Wand. Following simulation, the real patient is repositioned under vacuum control, the targeting device repositioned as well, and the actual brachytherapy initiated. The VBH head holder is well tolerated by patients and simple to use, and various studies have confirmed submillimeter accuracy. The modified head holder in combination with a new targeting device allows for precise and well-planned insertion of hollow needles into a tumor using frameless stereotactic systems as well as being compatible for uses in other fields.

Brachytherapy↗
PubMed1997

Minimally invasive head holder to improve the performance of frameless stereotactic surgery.

Frameless stereotactic procedures crucially depend on the firmness of immobilization. Once registered, shifting of the patient leads to inaccuracy, and the patient registration has to be realigned. To overcome the drawbacks of conventional invasive fixation for neurosurgery and the widely accepted fixation with surgical tape in ENT, the Vogele-Bale-Hohner (VBH) head holder has been developed. It permits rigid, noninvasive fixation of the head by using an individualized dental cast attached to the upper jaw by vacuum. Oral intubation is uncomplicated. In addition, a special registration device providing well defined reference points can be mounted to the mouthpiece. We report the first promising clinical applications of this device.

Adenocarcinoma↗
PubMed1997

Three-dimensional image-guided endonasal surgery with a microdebrider.

We report the first intraoperative use of a microdebrider as a stereotactic three-dimensional (3D) navigation instrument in paranasal and frontobasal surgery. The microdebrider uses rotating blades and an integrated suction device for controlled removal of tissue under video-endoscopic view. The ISG Viewing Wand uses the patient's computed tomography/magnetic resonance (CT/MR) data and a 3D reconstruction thereof and a high-precision position-sensitive mechanical arm for intraoperative three-dimensional navigation. We have linked the microdebrider to the Viewing Wand to transform it into a continuously available intraoperative stereotactic localizing device. We discuss the problems related to this extension of the Viewing Wand and demonstrate the practical use in an exemplary polypectomy.

Debridement↗