text: With our long history as an innovator in the area of cranial treatments for both surgery and radiosurgery, Brainlab continuously aims for increased efficiency in delivery and planning for cranial SRS treatments. Our à la carte software applications, called Elements, enable fully optimized cranial treatments with the planner still in the driver’s seat. Providing tools to clinicians with a high grade of automation supports clinicians in delivering safer treatments, improving efficiency in their daily routine and ultimately utilizing the software for more patients.
  When developing our latest software, we took the quality of positioning, dosimetry and the plan into account. All this lead to the creation of indication-specific Elements Cranial SRS, which thus far includes, but is not limited to arteriovenous malformations (AVM), pituitary adenomas, vestibular schwannomas, meningiomas and large metastases.
  The Cranial SRS planning workflow is straightforward with the flexibility to configure planning templates according to individual clinical protocols and starts with easy-to-use and fast preplanning tools: Dataset co-registration using Image Fusion with Cranial Distortion Correction, Anatomical Mapping for labeling all tissue classes of MR datasets to identify organs at risk, tumor definition with SmartBrush or nidus definition with Smartbrush Angio*, followed by the final treatment planning with Cranial SRS after just a few minutes.
  After a similar automated pre-planning process, Elements Multiple Brain Mets SRS dose planning enables the delivery of highly conformal single-session treatments for up to ten or more metastases while helping to minimize dose spread to surrounding healthy tissue. Elements Adaptive Hybrid Surgery (AHS) is dedicated to multi-modality treatment of benign skull base tumors and offers a method for radiosurgery guided neurosurgery. The Elements portfolio is completed by Elements Contrast Clearance Analysis, a novel MRI-based methodology for the high resolution depiction of contrast clearance and accumulation, allowing for the differentiation of brain regions with high and low vascular activity.
  In combination with Elements, in-room X-Ray based ExacTrac Positioning and Monitoring system allows for highly accurate position verification and monitoring of patient motion and internal anatomical shifts during treatment.
  Neuropathy is common in the diabetic population, affecting approximately 50% of patients with long-lasting diseases. The most common type is symmetric distal sensorimotor polyneuropathy, in which pain is a dominant symptom.
  Although painful neuropathy responds to antidepressants, anticonvulsants and opioid agonists, these drugs are often ineffective or can induce severe adverse effects. Hence, to manage this condition effectively, there is a need to seek other safe and effective therapeutic options.
  Invasive neurostimulation techniques are already used successfully to treat drug-resistant neuropathic pain, including brain stimulation and epidural motor cortex stimulation.
  BrainsWay’s* treatment offers an effective*, safe and non-invasive treatment that uses Deep Transcranial Magnetic Stimulation (TMS) to treat chronic pain. The treatment performs magnetic stimulation of brain structures and networks related to chronic pain. It can be used to modulate cortical excitability and inhibit pain perception in the brain to bring significant improvement to patients.
  Standard TMS coils (such as the figure-of-eight coil) permit stimulation of only superficial cortical regions of the human brain, because the higher stimulus intensities required to affect deeper brain areas increase the risk of adverse effects. BrainsWay’s H-coil allows brain stimulation without significantly increasing the intensity of induced fields in superficial cortical regions. The H-coil can therefore be used to stimulate the lower-limb motor cortex, an area that lies in interior sections of the motor area, tucked deep in the medial longitudinal fissure.
  A recent study used Deep TMS over the deeper leg motor cortex to treat patients suffering from diabetic neuropathic pain (see link below). Twenty-five patients were enrolled and treated with the HMMC-coil, which is designed for effective activation of neuronal structures in the motor cortex, including the deeper structures of the leg motor cortex, with hemispheric symmetry. Patients were randomly assigned to receive daily active or sham Deep TMS for 5 consecutive days. Sham/active treatment sessions were applied in crossover design with intervals of 5 weeks.
  The analgesic effect of Deep TMS therapy (real vs. sham) was evaluated by measurements of visual analogue scale (VAS) and the nociceptive flexion RIII reflex.
  Repeated measures ANOVA showed a significant decrease subjective pain sensation (as measured by the VAS) in the active but not the sham group (p=0.01); and in RIII reflex threshold (p<0.01) following active but not sham treatments. The improvements in both VAS scores and RIII reflex thresholds were preserved 3 weeks after the last active session.
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