Stereotactic Surgery
 
Neurosurgery Information

 

Stereotactic Surgery......    
Peripheral Nerve
Functional
Paediatric Neurosurgery

The term "Stereotactic" is derived from the Greek words "Stereo" which means three-dimensional and "taxic" which refers to system or arrangement. "Tactus" is a Latin verb for touch.

Stereotactic neurosurgery refers to image-guided neurosurgery which offers the surgeon an accurate three-dimensional touch, so to speak.
It is an invaluable tool in localisation. Broadly speaking, stereotactic neurosurgery employs either 'frame based' or 'frameless' techniques.

In frame-based stereotaxy, a stereotactic frame is fixed to the skull. With the aid of CT or MRI scans, this is used as a rigid co-ordinate system to localise any particular point in the patient's brain accurately. It allows the surgeon to perform surgery at an unseen target with precision.

In frameless systems, a computer-interface known commonly as a neuronavigation device is used to register a patients physical space to the corresponding images on the CT or MRI scans. This method of spatial localisation gives real-time feedback from the surgical field, providing a kind of 'road-map' which tells the surgeon where exactly he is operating in, anatomically speaking.

     
  What are the uses of Frame-based Stereotaxy?    
  There are numerous frame-based systems like the CRW (Cosman-Roberts-Wells) and Leksell systems. They provide pin-point accuracy for localisation and are therefore commonly used in the following clinical situations:  
 
  1. Biopsy of brain tumours or other lesions
  - especially if the lesion is small, deep seated or in an eloquent area of the brain.
  2. Electrode placement
  - "deep brain stimulation" for chronic pain
  3. Lesion generation
  - movement disorders, eg, Parkinsonism
  4. Catheter placement
  - in complex shunt procedures
  - for drainage of deep lesions, eg, cysts
  5. Evacation of intracerebral haematomas
  6. Stereotactic Radiosurgery
 
     
  When are frameless systems employed?    
  There are many types of neuronavigation systems to guide surgical approaches to intracranial targets. These include the Stealth, Brain Lab and Radionics systems. While frame-based systems are more accurate, these frameless systems offer a wider and more flexible range of use. They allow for preoperative planning in determining the best approach that can be employed. It is also often used to minimise the length of the incision and hence potentially reduce the morbidity to the patient. Newer systems can be incooperated with the surgical microscope or neuroendoscope to assist the surgeon during the operation. This is invaluable at times. The clinical application of these systems therefore include:  
 
1.

Biopsy and resection of brain tumours

2. Surgery for arteriovenous malformations
  3. Spinal surgery; to assist in instrumentation
 
     
     
     
     
     
     
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