*Edited by Jose C. Jimenez-Lopez*

Dr. Jose C. Jimenez-Lopez finished his BS degree in Biochemistry and Molecular Biology (1998) and Biological Sciences (2001); MS degree in Agricultural Sciences (2004) at the University of Granada and the Spanish National Research Council (CSIC). He received his PhD degree in Plant Cell Biology (April 2008) from CSIC. He was a postdoctoral research associate in Plant Biology at Purdue University (USA) until 2011. He was awarded with a prestigious European grant (2012–2015) from the Marie Curie program (EU-FP7) to work at the University of Western Australia in nutraceutical aspects and health benefits of the legume *Lupinus angustifolius* and at CSIC in lupin molecular allergy. Currently, he holds a senior research fellow position at CSIC Ramon y Cajal Research Program, working in the functional characterization of proteins from plant reproductive (pollen and seed) tissues in plant species of agro-industrial interest as legumes and olive tree.

ISBN 978-953-51-3621-7

Advances in Seed Biology

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**5. Computer-assisted pancreas navigation**

Existing computer-assisted navigation solutions address the needs of the pancreatic MDs to some extent, yet there remains room for improvement. The application of IRE as a treatment for pancreatic cancer bears additional challenges, which are partially covered by existing solutions:

Low usage numbers of stereotactic needle guidance in the pancreatic use case highlights that not all problems have yet been addressed to support the complete perioperative procedure. A study recently published by He et al. [47] demonstrated the feasibility of robot-assisted percutaneous IRE treatment of pancreatic head cancer in 9 cases. With respect to spatial accuracy, the stereotactic percutaneous navigation outperformed the stereotactic laparoscopic navigation in existing reporting. Therefore, stereotactic percutaneous needle guidance can be seen as the foundation to achieve reliable and reproducible navigation results. Yet, it only constructs one part of a dedicated computer-assisted pancreatic IRE workflow.

#### **5.1 IRE planning tool**

Preoperative image data are essential to generate a safe and feasible ablation plan with an optimal needle configuration to treat the tumor. We developed a dedicated preoperative planning tool, which makes use of CT/MRI image data in combination with 3D reconstructions to simulate IRE needle configurations. The tool allows the MD to define target and entry positions on multiplanar reconstructions (MPR) of the tomographic images with the possibility to select different needle configurations (layout and spacing). Under consideration of IRE-related constraints (spacing and parallelism), the trajectories can be optimized to cover the region of interest. The segmentations are conducted by a radiologist using dedicated software and can be tailored upon the type of intervention. Unlike for the open approach, preoperative segmentations for a percutaneous approach could include structures like the stomach, colon, or liver as well. This information is beneficial for the determination of the access window and to evaluate risk structures in the vicinity of the needles.

The planning tool was evaluated in the course of a clinical study of IRE in a laparotomy setting at the local hospital (Inselspital, Bern, Switzerland). **Figure 6** demonstrates the application of the planning tool to 1 out of 10 cases. During the surgery, the decision was to place the needles according to plan # 1 as the superior mesenteric vein was not mobilizable enough to obtain a window for the inferior right needle in #2. The 3D planning tool proved beneficial in both the preoperative

**Figure 6.**

*Preoperative plan on axial plane with segmentation overlay (left). Two IRE configurations with 3D reconstructions (middle). Image plane at needle tip in direction of the trajectory to visualize distances between the needles in millimeter (right).*

as well as intraoperative phase as it increased the MDs spatial understanding during the generation of the ablation plan.


**Author details**

Alex Pacheco1 \*, Kevin Sánchez1 , Rosario Pariona2 , Nestor Cuba1 and Bertha Larico1

1 National University of Cañete - UNDC, Lima, Perú

2 National Autonomous University of Huanta - UNAH, Ayacucho, Perú

\*Address all correspondence to<EMAIL_ADDRESS>
© 2021 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


**10. Conclusion**

Infection with SARS-CoV-2 resulting in COVID-19 leads to damage of many organs in the body. The nervous system is also often assaulted by the virus and the subsequent immune response. The treatment options are limited. Vaccination to prevent the spread of SARS-CoV-2 and its variants is the most efficacious way to prevent nervous system disease in context with SARS-CoV-2 and COVID-19. Possibly, the insights that are obtained on the worldwide population level by SARS-CoV-2 and COVID-19 will result in a better understanding of the induction of autoimmune disease of the nervous system in general.