Enabling Systems for Neurosurgery

One of the major problems in neurosurgery is to find an optimal access route towards the area of interest, e.g., a lesion to be treated chirurgically. The quality of a route depends on the type of pathology to treat, its location, the functional areas surrounding it and many other aspects. The overall goal of route optimization is of course, to treat the patient as effectively as possible while minimizing additional damage. In addition, the operation field must be sufficiently accessible to the surgeon. To identify such a route, besides other aids, radiological images of the area of interest (often CT/MR-images) are consulted, and the decision is based on the location and extent of the pathology as discernible in the images, sometimes supported by functional MRI data. Unfortunately, two-dimensional images communicate only limited information about the spatial and structural relationships, although experienced radiologists and surgeons develop the ability to build mental models of the three-dimensional structures from the images alone. But this process takes much time and a lot of experience. Furthermore, surgeons and radiologists have to cooperate and come to a common understanding to find the optimum treatment. This proves difficult as they have radically different views on the patient. While radiologists often feel comfortable with stacks of two-dimensional images, the surgeon’s primary view is on what he finds once the skull is open. Computer technology can help to bridge the gap and shorten the discussion. Using the experiences from other medical projects we developed a software system that is built on the paradigm of enabling systems. This approach focuses on the cognitive processes that take place in the mind of experts and tries to support the less experienced user with cognitive aids that help to develop expertship faster and more easily. Under this paradigm, visualizations, algorithms, and technical aids are chosen primarily with respect to their ability to enable the user to gain insight into the data and the underlying processes. In the remainder of this article we give a short introduction into the paradigm, describe the application of enabling systems to neurosurgery and discuss our current system and its properties.