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Value of high-definition imaging in neuroendoscopy

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Abstract

To compare the image quality of a standard definition (SD) three-chip camera with a new high-definition (HD) three-chip camera. In five neurosurgical interventions, an SD three-chip camera and an HD three-chip camera were used with the same endoscopic equipment. Both cameras were used while performing one endoscopic third ventriculostomy, one endoscope-assisted microvascular decompression, one endoscope-assisted removal of a vestibular schwannoma, and two endonasal pituitary surgeries. To provide comparable conditions, the outputs of both cameras were displayed on the same flat screen and were recorded on hard disk with an appropriate workstation using a visually lossless codec. Both cameras were used with full light intensity and maximal zoom. The cameras were connected to the same rod-lens endoscopes (2.7- and 1.7-mm lens) one after the other. The image quality of the HD camera was far superior in all applications. Especially in pituitary surgery, the difference was striking when the tumor had to be differentiated from the normal pituitary tissue. Improved resolution and color information explained the better images in HD imaging. Additionally, because of the 16:9 aspect ratio, the viewing field of the HD camera was larger than with the 4:3 aspect ratio of the SD camera. The progressive image processing of the HD camera provided a much clearer image than the interlaced image processing of the SD camera, especially with a modern flat panel screen. HD imaging provides a much better image quality compared to SD imaging. Therefore, we recommend use of HD cameras in neuroendoscopic procedures.

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Disclosure

The first author (HWSS) is consultant to Karl Storz GmbH & Co. KG, Tuttlingen, Germany.

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Correspondence to Henry W. S. Schroeder.

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Comments

Nikolai Hopf, Stuttgart, Germany

Schroeder et al compared in this well-written paper the new high definition (HD) video technology with the standard definition (SD) technology. Image quality was analyzed during different neuroendoscopic procedures using the exact same equipment with exception of the two camera systems. Quality was estimated by rating different aspects of the image, such as color information, tissue differentiation, resolution, and viewing field. The HD system was found to be superior in all aspects. Even though this is not a big surprise, Schroeder et al. demonstrated for the first time this difference using a scientific approach. It is still very important to recognize that the better the surgeon sees, the better he is able to perform the operation. This is especially true for endoscopic operations, where blood and humidity may impair the vision. This paper is an excellent example how small technological improvements support minimally invasive neurosurgery in a great deal. I completely agree with the conclusion of the authors that HD systems should be used for all neuroendoscopic procedures.

Robert Reisch, Zurich, Switzerland

Endoscopic techniques offer several advantages in transcranial and transsphenoidal surgery. Advantages in visualization are the increased light intensity in the deep-seated surgical field and the clear representation of patho-anatomical details. In addition, the extended viewing angle of endoscopes enables surgeons to observe hidden parts of the surgical field.

However, image quality of conventional one- or three-chip camera units is clearly restricted compared with the excellence of a direct view into the surgical microscope. In the past, this inferior imaging has limited the application of endoscopes in cranial neurosurgery.

Recently, the intraoperative use of high definition (HD) image quality offers a new area in endoscopic neurosurgery with enlarged range of indications in transcranial and transsphenoidal surgery.

In this paper, Schroeder and Nehlsen describe their experiences with HD imaging in comparison with standard three-chip charge-coupled devices (3CCD) in typical conditions: during ETV, MVD, EAM, and transsphenoidal surgery. The HD and 3CCD camera units were used with the same endoscopic equipment; the authors describe the high definition technique and present the video documentation accurately.

Not surprisingly, the image quality of the HD camera was superior to the image of a standard three-chip camera in all procedures, according to a five-times-higher optical resolution. This superior quality was especially important in delicate conditions: by blurry vision in case of bloody CSF by ETV or by differentiation on adenoma from normal pituitary tissue by transsphenoidal surgery.

I agree with the authors in recommendation of HD cameras in neuroendoscopic procedures.

Veit Rohde, Göttingen, Germany

In three truly endoscopic and two endoscope-assisted operations, the authors used both a standard definition and a high definition three-chip camera for the endoscope and compared the image quality. Not surprisingly, the image quality with the high definition camera was superior, as it is proven by impressive intraoperative photographs.

Neurosurgery has witnessed tremendous technical advancements in the last two decades. During the same period of time, the intervals in which the industry had provided the neurosurgeon with a new or improved technology dropped substantially. These aspects lead to the major question which rises when reading papers comparing “not so new” with “new” technology: is it necessary to have again and again the latest technology in the operating room to perform state-of-the-art neurosurgery? My personal answer is no because operative results are much more influenced by the experience and skills of the neurosurgeon than by technology. Thus, the recommendation of the authors to use high-definition instead of standard-definition cameras routinely in neuroendoscopic procedures has to be questioned.

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Schroeder, H.W.S., Nehlsen, M. Value of high-definition imaging in neuroendoscopy. Neurosurg Rev 32, 303–308 (2009). https://doi.org/10.1007/s10143-009-0200-x

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