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INFRARED 800.BLUE 400.

We make it visible.

2

More Speed. Less Doubt. More Safety.

Check, interpret and make decisions during

the procedure – quickly, clearly and reliably.

The essentials of modern neurosurgery.

Intraoperative visualization methods supplement

the optics of the surgical microscope. They open

up new dimensions in vision and help close the

gap between speculation and certainty.

Carl Zeiss provides neurosurgery

with two innovative fluorescence options –

INFRARED 800 and BLUE 400. They support the

work of surgeons and supply them with vital

information, thereby enhancing efficiency.

INFRARED

800

INFRARED 800. Check the Outcome-Immediately.

INFRARED 800 switches fromwhite light to infrared at thepush of a button. Blood flow is shown white on ablack background. Any necessaryadjustments can be performedinstantly. Being able to simulta-neously perform an operationand confirm the results deliversa new degree of certainty, ahigher level of trust.

Aneurysm fills with blood.

Second check. Aneurysm is closed.

4

INFRARED

800

Aneurysm clips are placed.

First check. Aneurysm still fills with blood.

Aneurysm clip is adjusted.

Important vessels remain open.

INFRARED 800.Clarity. Confidence.

INFRARED 800 is completely integrated into

OPMI® Pentero®. No additional instruments to get

in the way or add extra weight. No rebalancing.

No reduction of the working distance.

User guidance – Familiar, very easy and intuitive.

The same as all functions on OPMI Pentero.

Activated and controlled via the OPMI Pentero

handgrip. Easily, at the push of a button.

The results are visible on the touchscreen or an

external monitor in brilliant quality.

They are automatically saved as digital videos.

Still images can also be taken.

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INFRARED

800

Decisive Benefits duringthe Operation.INFRARED 800 GuidesAutomatically to the Point.

AutoSetting. An initial press of a button on the

handgrip sets up the system automatically.

User guidance ensures optimum settings for

zoom and focus.

AutoRecord. Pressing the button again activates

the synchronous video recording of white light

and the infrared view.

AutoGain.

The brightness of the infrared image is auto-

matically adjusted to the respective application.

AutoReplay.

An important automatic repeat function for the

first seconds of the flow phase. During playback,

INFRARED 800 recognizes the start of the inflow

on the video and jumps directly to this sequence,

skipping over the blank recording -

AutoDetection.

Picture-in-Picture.

This additional function enables a direct optical

comparison of the white light and infrared

recordings.

The INFRARED 800 video and image data can

easily be transferred to a DVD or USB media.

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INFRARED

800

10

Study Results.

“[…] Microscope-based ICG videoangiography

represents a new technology for intraoperative

imaging of vascular flow.

Distinct advantages of this technique are its inte-

gration into the surgical microscope and its ability

to image perforating arteries with submillimeter

diameters. Its simplicity, speed, and high level of

accuracy for detecting incompletely clipped

aneurysms and inadvertently occluded vessels

support its use during aneurysm surgery.

Indocyanine green videoangiography may fill

in the gap between intraoperative Doppler ultra-

sonography and intraoperative DS angiography.

Although it cannot replace intraoperative DS

angiography in many cases, the ICG technique

has the potential to be more widely available than

the DS technique. Therefore, ICG videoangio-

graphy has the potential to achieve the goal of

routine intraoperative vascular imaging during

aneurysm surgery.”

”[…] In our study, the results of ICG videoan-

giography were available within 2 minutes for all

patients. This time frame allows the neurosurgeon

to act immediately to remove or correct the posi-

tion of an aneurysm clip before critical cerebral

ischemia can occur. Moreover, this imaging

technique can easily be repeated as needed.”

“[…] The technique was performed during 187

surgical procedures in which 124 aneurysms in

114 patients were clipped. Using a newly devel-

oped setup, the ICG technique has been

integrated into an operating microscope

(Carl Zeiss Co., Oberkochen, Germany).”

Raabe A, Nakaji P, Beck J et al: Prospective

evaluation of surgical microscope-integrated

intraoperative near-infrared indocyanine green

videoangiography during aneurysm surgery.

J Neurosurg 103:982-989, 2005.

Quotes:

Juha Hernesniemi, M.D., Ph.D.,

Professor and Chairman, Department of

Neurosurgery, Helsinki University Central

Hospital, Helsinki, Finland

“[…] The use of intraoperative indocyanine green

angiography […] is such a simple method, and

for us it would appear to be one of the greatest

developments in open microsurgery of cerebral

aneurysms in the last few years!”

Hernesniemi J, Niemelä M, Kivisaari R et al:

Commentary on the Article of A. Raabe, J. Beck, V.

Seifert: Technique and Image Quality of

Intraoperative Indocyanine Green Angiography.

During Aneurysm Surgery Using Surgical Microscope

Integrated Near-Infrared Video Technology.

Zentralbl Neurochir 66:7-8, 2005.

Robert F. Spetzler, M.D., Chairman and

Medical Director, Barrow Neurological

Institute, Phoenix, USA

“The opportunity to have an angiogram that is

so easy and allows you to manipulate the vessels

or the aneurysm while you are performing it, is

incredibly exciting to neurosurgeons.”

INFRARED

800

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Tumor under normal white light. Tumor glows red under BLUE 400 illumination.

BLUE 400. Visible Differences.

The intraoperative differentiation betweendiseased and healthy tissue structures isthe basis of the decision-making processfor the neurosurgeon. However, normalwhite light is sometimes insufficient. Thisis where help is provided by a new dimen-sion in vision. BLUE 400 visualizes what isonly suspected under standard white light.

BLUE

400

Direct visual control with BLUE 400.

Instantly and any time during the resection.

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BLUE 400. No Room for Doubt.

BLUE 400 was developed by Carl Zeiss in close

cooperation with neurosurgeons. The objective

was to create a highly integrated procedure

which supports the intuitive performance of

fluorescence-based surgeries.

The integration of BLUE 400 was part of the

OPMI Pentero design from the ground up. With

the BLUE 400 option and its special illumination, it

becomes clear: OPMI Pentero is built to fluoresce.

The complete integration of BLUE 400 into the

surgical microscope eliminates the need for other

external components that add extra weight or

impair working comfort.

BLUE 400 fits seamlessly into the familiar user

structure of OPMI Pentero. The system must only

be configured once for each surgeon and is stored

in the user settings. Surgeons can switch between

the xenon white light view and the BLUE 400

mode in the blink of an eye using the handgrip

or footswitch. The workflow remains unchanged.

The optionally integrated video documentation

in OPMI Pentero delivers fluorescence images

in a quality that leaves no room for doubt.

BLUE

400

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Study Results.

“[…] We have shown that use of 5-aminolevulinic

acid leads to a higher frequency of complete

resections of contrast-enhancing tumours on early

postoperative MRI, translating into higher progres-

sion-free survival, than does conventional micro-

surgery guided by white light. Postoperative

Karnofsky performance score, neurological status,

and toxic effects were much the same for both

groups, showing fluorescence-guided surgery with

5-aminolevulinic acid to be safe.”

“[...] From Oct 11, 1999, 322 patients were

enrolled by 32 investigators at 17 German study

centres. The last visit for the interim analysis was

done on July 19, 2004.

161 patients were randomly assigned to fluores-

cence-guided surgery with 5-aminolevulinic acid,

and 161 were randomly assigned to conventional

microsurgery with white light.”

“[…] Surgery was done by use of a modified neu-

rosurgical microscope ([...]with fluorescence kit,

Carl Zeiss Surgical GmbH, Oberkochen, Germany),

which enabled switching from conventional white

xenon illumination to violet-blue excitation light.“

Stummer W, Pichlmeier U, Meinel T et al:

Fluorescence-guided surgery with 5-aminolevulinic

acid for resection of malignant glioma:

a randomised controlled multicentre phase III trial.

Lancet Oncol 7:392-401, 2006.

Quotes:

Volker Seifert, M.D., Ph.D.,

Professor and Chairman, Department of

Neurosurgery, Johann Wolfgang Goethe

University, Frankfurt, Germany

“The quality and radicality of tumor resection,

especially for patients with glioblastoma, clearly

defines the outcome of the patient. In this regard,

the new integrated support of fluorescence-based

tumor resection is a unique and very helpful tool

to neurosurgeons.”

Jörg-Christian Tonn, M.D., Ph.D.,

Director, Neurosurgical Clinic and Polyclinic,

University of Munich Hospital, Munich,

Germany

“The normal white light illumination is often insuf-

ficient for displaying the tumor edges of glioblas-

tomas IV. After the administration of 5-ALA, the

entire tumor glows red and becomes very clear in

the fluorescence mode.

This is a very helpful indicator and assists the sur-

geon in deciding on the extent of the resection.”

BLUE

400

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Integration is the Future.

While developing OPMI Pentero, Carl Zeiss

envisioned a unique system incorporating the

most innovative features in a single microscope –

a vision that has taken two more steps towards

reality with the INFRARED 800 and BLUE 400

fluorescence options.

Integration is the key to optimizing all work

processes in the hospital.

Additional cutting-edge options such as DICOM

transform OPMI Pentero into a communication

platform.

Integration is the future.

And the future is now.

Technical data:

The options INFRARED 800 and BLUE 400 can

be integrated into OPMI Pentero. The technical

data of OPMI Pentero is included in the respective

documentation.

The integration of INFRARED 800 into OPMI

Pentero encompasses special filters for excitation

in the 700 – 780 nm wavelength range and

display in the 820 – 900 nm wavelength range.

Furthermore, INFRARED 800 contains optics and

a camera specially optimized for the INFRARED

800 mode.

The integration of BLUE 400 into OPMI Pentero

encompasses special filters for excitation in the

400 – 410 nm wavelength range and display in

the 620 – 710 nm wavelength range.

Furthermore, BLUE 400 contains optics and a cam-

era specially optimized for the BLUE 400 mode.

The unit meets the essential requirements stipulat-

ed in Annex I to the European Medical Device

directive 93/42/EEC.

0297

Carl Zeiss Surgical GmbH

73446 Oberkochen

Germany

Fax: +49 73 64 20-48 23

E-mail: surgical@zeiss.de

www.zeiss.com/neuro

www.zeiss.com/contacts

In Europe (EU), intraoperative fluorescence tech-

nologies are in compliance with the requirements

of the European Medical Device directive

93/42/EEC. They are also available in other mar-

kets, however, depending on national regulations,

additional authorization may be necessary in the

country in which the instrument and application

will be used. For further information please

contact your local Carl Zeiss sales representative.

Image courtesy of

Andreas Raabe, M.D., Ph.D., Department of

Neurosurgery, Johann Wolfgang Goethe University,

Frankfurt, Germany (p.4,5)

Robert F. Spetzler, M.D., Barrow Neurological

Institute, Phoenix, USA (p.7,8,9,11)

Walter Stummer, M.D., Department of

Neurosurgery, University of Düsseldorf, Düsseldorf,

Germany (p.12,13,15)

Johann Wolfgang Goethe University,

Department of Neurosurgery, Frankfurt, Germany

(p.17)

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OPMI and Pentero are registered trademarks of Carl Zeiss.