Stereotactic Approach to the Trigeminal Ganglion Using a Stereotactic Frame and Intraoperative Computed Tomography Scans: Technical Note

Abstract A computed tomographic-stereotactic system based on the Leksell stereotactic frame has been used to implant radioactive 125I sources into (28 procedures) or to biopsy (2 procedures as biopsy only, 2 in conjunction with the implantation of a radioactive source) malignant brain tumors. In every instance, the selected target was reached precisely, allowing accurate diagnosis and treatment.

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Intraoperative Computed Tomography for Registration of Stereotactic Frame in Frame-Based Deep Brain Stimulation

Neurosurgery ◽

10.1093/neuros/opaa361_s163 ◽

2021 ◽

Vol 89 (Supplement_2) ◽

pp. S163-S163

Author(s):

Michael R Jones ◽

Archit B Baskaran ◽

Mark J Nolt ◽

Joshua M Rosenow

Keyword(s):

Computed Tomography ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Intraoperative Computed Tomography ◽

Stereotactic Frame ◽

Deep Brain

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Intraoperative Computed Tomography for Deep Brain Stimulation Surgery: Technique and Accuracy Assessment

Operative Neurosurgery ◽

10.1227/neu.0b013e31820781bc ◽

2011 ◽

Vol 68 (suppl_1) ◽

pp. ons114-ons124 ◽

Cited By ~ 23

Author(s):

Kiarash Shahlaie ◽

Paul S Larson ◽

Philip A Starr

Keyword(s):

Computed Tomography ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Intraoperative Computed Tomography ◽

3 Dimensional ◽

Postoperative Mri ◽

Stereotactic Frame ◽

Head Positioning ◽

Lead Location ◽

Deep Brain

Abstract BACKGROUND: The efficacy of deep brain stimulation (DBS) is highly dependent on the accuracy of lead placement. OBJECTIVE: To describe the use of intraoperative computed tomography (iCT) to confirm lead location before surgical closure and to study the accuracy of this technique. METHODS: Fifteen patients underwent awake microelectrode-guided DBS surgery in a stereotactic frame. A portable iCT scanner (Medtronic O-arm) was positioned around the patient's head throughout the procedure and was used to confirm lead location before fixation of the lead to the skull. Images were computationally fused with preoperative magnetic resonance imaging (MRI), and lead tip coordinates with respect to the midpoint of the anterior commissure-posterior commissure line were measured. Tip coordinates were compared with those obtained from postoperative MRI. RESULTS: iCT was integrated into standard frame-based microelectrode-guided DBS surgery with a minimal increase in surgical time or complexity. Technically adequate 2-dimensional and 3-dimensional images were obtained in all cases. Head positioning and fixation techniques that allow unobstructed imaging are described. Lead tip measurements on iCT fused with preoperative MRI were statistically indistinguishable from those obtained with postoperative MRI. CONCLUSION: iCT can be easily incorporated into standard DBS surgery, replaces the need for C-arm fluoroscopy, and provides accurate intraoperative 3-dimensional confirmation of electrode tip locations relative to preoperative images and surgical plans. iCT fused to preoperative MRI may obviate the need for routine postoperative MRI in DBS surgery. Technical nuances that must be mastered for the efficient use of iCT during DBS implantation are described.

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Evaluation of new radiolucent polymer headholder pins for use in intraoperative computed tomography

Journal of Neurosurgery ◽

10.3171/2009.1.jns08862 ◽

2009 ◽

Vol 111 (6) ◽

pp. 1168-1174 ◽

Cited By ~ 4

Author(s):

Ardeshir Ardeshiri ◽

Christian Radina ◽

Martin Edlauer ◽

Ardavan Ardeshiri ◽

Alfred Riepertinger ◽

...

Keyword(s):

Computed Tomography ◽

Mechanical Behavior ◽

Intraoperative Complications ◽

Clinical Routine ◽

Intraoperative Computed Tomography ◽

Computed Tomography Scans ◽

Special Force ◽

The Brain ◽

Potential Use ◽

Penetration Depths

Object With the introduction of intraoperative CT (iCT) scanning, neurosurgeons can now obtain images of the brain during surgery, offering the possibility of intraoperative resection control and monitoring of potential intraoperative complications. The combination of iCT with neuronavigation makes it possible to update the reference scans intraoperatively when necessary. However, the headholder pins normally used for iCT scanning still show artifacts. In the present study, new polymer pins, producing nearly no artifacts in laboratory tests, are compared with the usual pins with regard to their mechanical and artifact behavior to evaluate their potential use in the clinical routine. Methods Pins made of different materials (titanium, Macor, silicon nitride, zirconium oxide, sapphire, polyetheretherketone, and polyparaphenylene copolymer) were used for the fixation of 10 cadaveric heads. Special force sensors measured the fixation pressure of the pins, and histological analysis revealed the penetration depth. Computed tomography scans of a head phantom, fixed with the different pins, were obtained to reveal artifact behavior. Results All pins were biocompatible. Pins did not differ significantly in fixation pressures and mechanical behavior. Penetration depths were comparable (maximum 1.4 mm) and did not cause opening of the diploe. Polymer pins made of polyparaphenylene showed the best results in artifact behavior in CT scans. Conclusions The authors' results demonstrate that the new polymer pins are comparable in their mechanical behavior to the usual pins but superior in artifact behavior. Therefore, their use in the clinical routine of iCT scanning will be beneficial for the surgeon.

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