Stereotactic and Functional Neurosurgery

Intracranial Stereotactic Surgery: Indications

Introduction The indications for stereotactic neurosurgical methods have, at one point or another, encompassed all major categories of differential diagnoses. Stereotactic techniques, introduced in the early 20th century, applied instrumentation in a minimally invasive, precise, and reproducible manner for research purposes. The first report of a stereotactic device in the English language literature is the […]

Stereotactic Frames: Technical Considerations

Introduction The term stereotaxis, derived from the Greek stereo- for "three-dimensional" and -taxic for "an arrangement,” was coined by Horsley and Clarke in 1908 [1]. It was their use of a three-dimensional Cartesian coordinate system that provided the basis for all stereotactic systems used in modern day neuro-surgery. Human stereotaxy was initially developed for the […]

Stereotactic Surgery with the Radionics Frame

Introduction In the early 1980s Radionics, Inc. (Burlington, MA) was approached with a design for an innovative stereotactic frame that used computed tomography (CT) to directly target points within the brain. This device, the Brown-Roberts-Wells (BRW) frame, used a polar coordinate concept to define ste-reotactic space. A small computer with a simple menu was part […]

Stereotactic Surgery with the Leksell Frame

Lars Leksell It is well to reflect on the seminal contributions of Lars Leksell as we embrace new technology as a matter of course in the 21st century. A flurry of recent articles has appeared, for example, on the use of radiosurgery in trigeminal neuralgia. Few contemporary clinicians are aware that Leksell, in fact, pioneered […]

Stereotactic Surgery with the Zamorano-Dujovny Frame

Introduction Modern stereotaxis implies that application of all space-defining devices to reach the selected target. The Zamorano-Dujovny (Z-D) stereotactic head frame (F. L. Fischer, Freiburg, Germany) was developed for several reasons: to provide a stable referencing system for several types of imaging studies, such as conventional X-rays, computed tomography (CT), magnetic resonance imaging (MRI), or […]

Stereotactic Surgery with the Patil Frame

Introduction The Patil frame is designed to allow surgeons to measure coordinates directly on the scanner screen and obtain intraoperative images to confirm accuracy of the procedure. It is a center of the arc system and modification of the original Patil frame [1]. The frame (Fig. 1) consists of a fiducial plate, a head-ring, a […]

Frameless Stereotactic Systems: General Considerations

Introduction Neurosurgeons continuously strive to improve the safety and effectiveness of their interventions. Stereotactic neurosurgery uses imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) to serve as spatial guides for the surgeon. These spatial guides provide patient-specific anatomical roadmaps which, although not a replacement for knowledge of neuroanatomy, aid the surgeon […]

Surgical Navigation with the BrainLAB System (Stereotactic and Functional Neurosurgery)

Introduction The need to precisely localize targets within the brain and to refer them to important anatomical structures has occupied neurosurgeons since the early years of intracranial surgery. Craniometry, developed by neuroanatomists in the 19th century, was the first practical method of surgical navigation. It is still being used today as a crude but useful […]

Surgical Navigation with the Voyager System (Stereotactic and Functional Neurosurgery) Part 1

Introduction Our early interest in development of a surgical navigation system arose from our background in computer-assisted frame stereotaxy [1,2] and the early development of "frameless stereotaxy” devices by Roberts et al. [3,4] and Watanabee et al. [5]. Roberts’ group had devised a stereotactic surgical microscope using a sonic three-dimensional digitizer to locate the optical […]

Surgical Navigation with the Voyager System (Stereotactic and Functional Neurosurgery) Part 2

Target and Trajectory Guidance Voyager (then ViewPoint) was the first of the commercial surgical navigation systems to incorporate an intuitive, graphical means of target and trajectory guidance [9]. This was facilitated by its ability to display images oriented to the pointing device (e.g., wand). A target (with optional entry) point is defined by clicking on […]

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