1. Spinal and Posterior Fossa Endoscopic Anatomy using Percutaneous Intraspinal Navigation Phillip Purdy, M.D., Babu Welch, M.D., Roberta Novakovic, M.D., Susan Miller, R.T. UT Southwestern Medical Center, Dallas, Texas Takuya Fujimoto, PhD, M.D. Hyogo Cancer Center, Japan Phillip Purdy, M.D., Babu Welch, M.D., Roberta Novakovic, M.D., Susan Miller, R.T. UT Southwestern Medical Center, Dallas, Texas Takuya Fujimoto, PhD, M.D. Hyogo Cancer Center, Japan

2. Percutaneous Intraspinal Navigation (PIN) A minimally invasive technique utilizing lumbar puncture to access the subarachnoid space, followed by navigation of the subarachnoid space using a catheter, endoscope, etc. for potential intervention in the brain or spinal cord.

3. Cadaver Data – initial study (AJNR, March 2003)  2 fresh human cadavers  Demonstrated feasibility of navigation from lumbar puncture to multiple intracranial sites without violating the spinal cord  Done solely under fluoroscopic control  Included navigation to Sylvian fissure, middle cranial fossa, 3 rd and 4 th ventricles, suprasellar cistern and around frontal tips, and posterior to cerebellum  Demonstrated ability to navigate either anterior or posterior to spinal cord  2 fresh human cadavers  Demonstrated feasibility of navigation from lumbar puncture to multiple intracranial sites without violating the spinal cord  Done solely under fluoroscopic control  Included navigation to Sylvian fissure, middle cranial fossa, 3 rd and 4 th ventricles, suprasellar cistern and around frontal tips, and posterior to cerebellum  Demonstrated ability to navigate either anterior or posterior to spinal cord

6. Endocranial Endoscopy Initially demonstrated with 1mm fiberoptic scope introduced via “Tracker 38” Catheter tip Scope

7. Endocranial Endoscopy

8. Fiberoptic Endoscopic Technologies  Steerability  Working Lumen  Video now digitized via analog/digital converter and transferred directly into Mac laptop, then edited using iMovie software  Scope primarily used for this study is a 2.5mm diameter Storz scope indicated primarily for urologic use. 65 cm length. 1mm working channel.  Steerability  Working Lumen  Video now digitized via analog/digital converter and transferred directly into Mac laptop, then edited using iMovie software  Scope primarily used for this study is a 2.5mm diameter Storz scope indicated primarily for urologic use. 65 cm length. 1mm working channel.

9. Fluoro Images - access

10. Navigation Along Spinal Cord

11. Along Basilar Artery

12. Anatomy - review

13. Lower Cranial Nerves (9-11) Magendie

14. CN 7,8 entering IAC

15. CN 5

16. CN 3

17. Mamillary Bodies

18. Fluoro Image – Scope in posterior fossa

19. Pituitary Stalk, Optic Nerve

20. Conclusions  Percutaneous Intraspinal Navigation offers a significant opportunity to access CNS structures in a minimally invasive approach  Specific technologies for surgical intervention such as stem cell introduction in MS warrant development.  Early application of the technique for rhizotomy or cordotomy warrants investigation for control of severe pain.  Percutaneous Intraspinal Navigation offers a significant opportunity to access CNS structures in a minimally invasive approach  Specific technologies for surgical intervention such as stem cell introduction in MS warrant development.  Early application of the technique for rhizotomy or cordotomy warrants investigation for control of severe pain.