Computed Tomography-guided Stereotactic Surgery

Abstract

Computed tomography (CT) has become the first modality to provide the patient's self-brain map for stereotactic neurosurgery. This paper describes our development of a nearly artifact-free stereotactic frame designed for CT imaging. The surgical procedure is performed within the CT scanner itself. The scanner's computer, via a new software program, spatially integrates the new stereotactic frame with the CT images of the patient and with the scanner gantry to provide rapid coordinate determinations, calculate potential probe trajectories, obtain target accuracy within 1 mm, and observe for any procedural complications. Our initial clinical experience with this system is described.

The History and Mathematics of the N-Localizer for Stereotactic Neurosurgery

“…Kondziolka and Lunsford of the University of Pittsburgh School of Medicine have claimed [11], "At our center, the first CT compatible stereotactic head frame, in collaboration with industry, was constructed in 1978 and utilized in 13 patients [10,12]. [...] During this interval, the newly redesigned Leksell CT compatible stereotactic head frame [9] was used for dedicated brain biopsies under the direction of its inventor, Lars Leksell.…”

The N-Localizer and Volume Imaging

“…Despite its ubiquitous use, this equation applies to only three N-localizers. Some applications of the N-localizer have incorporated four N-localizers [9][10][11][12][13][14] and hence have required that one of the four N-localizers be ignored in order to apply Equation 5. Recently, however, the mathematics of the N-localizer have been extended to apply to three or more Nlocalizers and thus have eliminated the requirement to discard one of the N-localizers [5].…”

The Origin of the N-Localizer for Stereotactic Neurosurgery

“…When Perry, et al subsequently proposed an image-guided stereotactic system that comprised N-localizers instead of slotted plates [4], they cited one [16] of Brown's two journal articles that had introduced the N-localizer more than one year previously [2,16]. Several months before Perry, et al proposed their image-guided stereotactic system, Brown, et al had already proposed the BRW image-guided stereotactic system [7].…”

“…Together, we developed an image-guided stereotactic system using the now well-known N-localizer technology. This elegant solution was proposed by Perry, et al [4] and Rosenbaum, et al [5] independently and virtually simultaneously as publications from Brown [2] and Roberts and Brown [6] of Utah. "…”

“…Perry, et al did propose an image-guided stereotactic system [4] several months after Brown, et al proposed the BrownRoberts-Wells (BRW) image-guided stereotactic system [7]. However, the historical record shows that none of the above-mentioned individuals, with the exception of Brown, invented the N-localizer.…”