Original Paper
Frameless Localization for Functional Neurosurgical Procedures: A Preliminary Accuracy StudyHenderson J.M.St. Louis University, St. Louis, Mo., USA
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Article / Publication Details
Published online: December 10, 2004
Issue release date: December 2004
Number of Print Pages: 7
Number of Figures: 5
Number of Tables: 3
ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)
For additional information: https://www.karger.com/SFN
Abstract
Background: Targeting for functional stereotactic procedures is traditionally carried out in a noninteractive fashion, without real-time positional feedback. In addition, stereotactic frames are uncomfortable for patients and may impede intraoperative neurological evaluation. As an initial step toward a fully frameless approach to functional surgery, we have investigated the use of an image-guided microdrive coupled to a stereotactic frame system. Methods: For initial laboratory tests, a stereotactic phantom was imaged using high-resolution CT scanning. Three representative targets were chosen within the phantom. Targeting was carried out in the usual fashion using the StealthStation planning suite, utilizing the Radionics CRW system. An LED-equipped reference arc was attached to the CRW base ring. Registration of the base ring was accomplished using a spherical probe. A custom-built microdrive was fitted with an LED array, mounted on the CRW arc and tracked by the StealthStation. The distance between the Stealth real-time localization and the CRW localization was measured on-screen. To evaluate the accuracy of the system in the operating room, a similar procedure was carried out in 13 functional neurosurgical operations (pallidotomy or deep brain stimulator placement). Results: Errors of localization in the laboratory setting ranged from 0.53 to 0.70 mm. In 11 operative cases, the average difference between the CRW localization and the Stealth localization was 1.77 mm. In the remaining 2 cases, equipment malfunction prevented measurement of localization error. Conclusions: Frameless image-guided localization compares favorably to targeting performed noninteractively. In addition, real-time positional feedback confers advantages in target region visualization and confidence in placement of lesions and stimulators for functional procedures. With small improvements in accuracy and system reliability, fully frameless functional procedures could be safely carried out.
© 2004 S. Karger AG, Basel
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Article / Publication Details
Published online: December 10, 2004
Issue release date: December 2004
Number of Print Pages: 7
Number of Figures: 5
Number of Tables: 3
ISSN: 1011-6125 (Print)
eISSN: 1423-0372 (Online)
For additional information: https://www.karger.com/SFN
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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