Stereotactic and Functional Neurosurgery

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

Introduction Over the past decade, image-guided surgery has become one of the most exciting new technologies for the neurosurgeon. Advances in techniques and instrumentation have been rapid [1-9]. The Mayfield® ACCISS™ image-guided stereotactic workstation (OMI system) has been developed to meet the image-guided needs of the most demanding surgeons (Fig. 1). With the May-field ACCISS, […]

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

Surgical Experience with the Mayfield ACCISS System Since its introduction in late 1994, the author has used the Mayfield ACCISS in approximately 300 image-guided assisted procedures (Table 1). A wide variety of applications has shown its versatility and dependability for the full gamut of image-guided neurosurgery with little if any time added to the procedure. […]

Surgical Navigation with the StealthStation (Stereotactic and Functional Neurosurgery)

Introduction The availability of powerful computer workstations the size of a personal computer, along with new technology for tracking the position of a probe in 3-dimensional space, spurred certain far-seeing neurosurgical investigators to develop turnkey systems for navigation in neurosurgery. Dr. Richard Bucholz, a neurosurgeon at St. Louis University, saw the surgical potential in infrared […]

Stereotactic Radiosurgery: Indications and General Technical Considerations

Introduction In 1951 Lars Leksell coined the term stereotactic radiosurgery (SRS) [1]. A ceaseless innovator, his goal was to develop a method for ”the non-invasive destruction of intracranial . . . lesions that may be inaccessible or unsuitable for open surgery” [2]. The first procedures were done using an orthovoltage X-ray tube mounted on an […]

Stereotactic Radiosurgery for Benign Tumors Part 1

Introduction The use of stereotactic radiosurgery (SRS) to treat patients with benign tumors is still debatable. However, a consensus exists in favor of SRS for patients with high surgical and anesthesiological risk, patients of advanced age, and those who refuse open surgery for other reasons. Benign tumors in eloquent areas pose considerable surgical risks. Unrelated […]

Stereotactic Radiosurgery for Benign Tumors Part 2

Tumors of the Pituitary Region Using SRS to treat patients with pituitary tumors is a challenging task. There is a risk of radiation damage to optic nerves, optic chiasm, or the hypo-thalamus, especially with larger tumors. The possibility of control of tumor growth and pituitary endocrinopathy without producing pituitary failure is a relatively new but […]

Stereotactic Radiosurgery: Gliomas

Introduction Stereotactic radiosurgery for the treatment of primary malignant gliomas is counterintuitive. Radiosurgery provides a high dose of ionizing radiation to a small, well-defined volume of tissue, whereas gliomas tend to be large, diffuse, and infiltrating. Nevertheless, standard therapeutic approaches in the management of gliomas yield discouraging results, with the majority of patients diagnosed with […]

Stereotactic Radiosurgery: Arteriovenous Malformations

Introduction The most devastating presentation associated with arteriovenous malformations (AVMs) of the brain is intracerebral hemorrhage. Numerous natural history studies have demonstrated a substantial (3% to 4% per year) risk of hemorrhage in patients harboring AVMs [1-5]. Several treatment modalities (microsurgery, radiosurgery, or endovascular therapy) are available that may eliminate the lesion before a hemorrhage […]

Stereotactic Radiosurgery with the Gamma Knife Part 1

Stereotactic Radiosurgery Surgeons use energy in many forms to cure disease. Scalpels, lasers, and electrocautery were the initial tools of the neurosurgeon. Recent advances in neuroimaging, computer science, and stereotactic dose planning allow neurosurgeons to use sculpted radiation fields to alter the biology of disease. Stereotactic radiosurgery is the mechanically precise delivery of a potentially […]

Stereotactic Radiosurgery with the Gamma Knife Part 2

Brain Metastases More than 100,000 patients are diagnosed with brain metastasis annually. The management of brain metastasis patients remains a challenge for oncologists, radiation oncologists, and neurosurgeons. Traditional therapy of single metastasis has been either resection or whole brain radiation (WBRT), with a boost to the affected region, or combined surgery with whole brain radiation. […]

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