The Application Accuracy of Stereotactic Frames

Maciunas, Robert J.; Galloway, Robert L.; Latimer, Jim

doi:10.1097/00006123-199410000-00015

Cited by 150 publications

(193 citation statements)

References 22 publications

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“…Hall et al [29] found a euclidean error of 1.53 mm using a Leksell frame and MRI imaging in a phantom model. In a large phantom model study, Maciunas et al [30] found that while the mean mechanical errors of the CRW and BRW frames were less than 1 mm, at a 99.9% confidence interval they can only be expected to achieve a mechanical accuracy of 2 mm or less. When factors such as imaging, point selection, and vector calculations were all considered, the ''application error'' at the 99.9% confidence interval increased to 3.1-5.0 mm for four different frame systems.…”

Section: Frameless Stereotaxy: a Hypothetical Cohortmentioning

confidence: 99%

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Owen

Linskey

2009

J Neurooncol

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Introduction In the modern era of frameless stereotaxis (FL), the role of frame-based (FB) stereotactic needle biopsy is evolving. Methods Retrospective review of prospective database of 106 lesions in 91 consecutive patients undergoing FB stereotactic needle biopsy with a systematic ''geologic core'' technique by a single surgeon. Diagnostic accuracy was calculated comparing biopsy diagnosis with final pathology in 11 patients who underwent subsequent surgical resection. All instances of intra-operative bleeding through the needle were prospectively noted and compared with post-biopsy CT scan. Lesions were classified as risky for FL technique if they were (1) infratentorial or pineal, (2) within 10 mm of the circle of Willis or root of the Sylvian fissure, or (3) within 10 mm of deep cerebral veins. Results Diagnostic yield was 94%. Diagnostic accuracy was 91%. Of 18 lesions involving the corpus callosum, 13 (72.2%) were GBM 2 were anaplastic astrocytoma, and 1 each were found to be anaplastic oligodendroglioma, primary central nervous system lymphoma (PCNSL) and tumescent MS. Of 25 multifocal lesions, malignant primary brain tumor was diagnosed in 17 (68%) (11 GBM, 3 PCNSL, 2 anaplastic ologodendroglioma, and 1 anaplastic astrocytoma). Mortality was 0%. Three patients developed temporary neurologic deficits and one had permanent deficit. Absence of persistent blood through the biopsy needle had a negative predicative value of 98.8% for subsequent neuroimaging blood [5 mm diameter. According to our criteria, 80% of patients would have been candidates for FL biopsy. Conclusions Stereotactic biopsy is an effective, safe and important technique for histologic diagnosis of brain lesions, particularly for multifocal and corpus callosum lesions. Postbiopsy CT can be safely reserved for patients who demonstrate persistent bleeding through the biopsy needle. FB stereotaxy remains an important technique for the 20% with small or deep seated lesions or when it is advantageous to avoid an incision, a burr hole or general anesthesia.

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Section: Frameless Stereotaxy: a Hypothetical Cohortmentioning

confidence: 99%

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Owen

Linskey

2009

J Neurooncol

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“…The position of the stimulating electrode in this patient was just medial to the STN, as defined by the 3D brain atlas. While the surgical goal is placement within the STN, the estimated electrode location in this patient-specific model is within the inherent error of the stereotactic neurosurgical procedure (Maciunas et al, 1994) and the brain atlas warping (Christensen et al, 1997;Nowinski et al, 2005).…”

Section: Image Coregistration and Brain Atlas Warpingmentioning

confidence: 99%

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

et al. 2007

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Despite the clinical success of deep brain stimulation (DBS) for the treatment of movement disorders, many questions remain about its effects on the nervous system. We have developed a methodology to predict the volume of tissue activated (VTA) by DBS on a patient-specific basis. Our goals are to identify the intersection between the VTA and surrounding anatomical structures and to compare activation of these structures with clinical outcomes. The model system consists of three fundamental components: 1) a 3D anatomical model of the subcortical nuclei and DBS electrode position in the brain, each derived from magnetic resonance imaging (MRI); 2) a finite element model of the DBS electrode and electric field transmitted to the brain, with tissue conductivity properties derived from diffusion tensor MRI; 3) VTA prediction derived from the response of myelinated axons to the applied electric field, which is a function of the stimulation parameters (contact, impedance, voltage, pulse width, frequency). We used this model system to analyze the effects of subthalamic nucleus (STN) DBS in a patient with Parkinson's disease. Quantitative measurements of bradykinesia, rigidity, and corticospinal tract (CST) motor thresholds were evaluated over a range of stimulation parameter settings. Our model predictions showed good agreement with CST thresholds. Additionally, stimulation through electrode contacts that improved bradykinesia and rigidity generated VTAs that overlapped the zona incerta / fields of Forel (ZI/H2). Application of DBS technology to various neurological disorders has preceded scientific characterization of the volume of tissue directly affected by the stimulation. Synergistic integration of clinical analysis, neuroimaging, neuroanatomy, and neurostimulation modeling provides the opportunity to address wide ranging questions on the factors linked with the therapeutic benefits and side effects of DBS.

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“…Each technique has advantages and disadvantages in matters of precision (van den Elsen et al, 1982;Maciunas et al, 1994), covered field of acceptable precision (Luebbers et al, 2008), and, of course, harm to the patient when it comes to such invasive techniques as bone-anchored fiducials (Sinikovic et al, 2007).…”

Section: Introductionmentioning

confidence: 99%

Registration for computer-navigated surgery in edentulous patients: A problem-based decision concept

Lübbers

Matthews

Zemann

et al. 2011

Journal of Cranio-Maxillofacial Surgery

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BACKGROUND: Surgical navigation is a commonly used tool in cranio-maxillofacial surgery. Registration is the key element for precision, and a number of studies have shown different techniques to be accurate. Nonetheless, uncertainty surrounds the special situation in edentulous patients and a practical approach to what can be a challenging problem. MATERIALS AND METHODS: Four registration strategies for the Brainlab VectorVision(2) system are presented for surgical navigation of edentulous patients: three landmark-based, point-to-point techniques and one surface-based matching strategy are evaluated. RESULTS: The methods described differ in overall accuracy as well as in the region covered. In general, the more time-consuming and invasive the technique, the more precise it is. The non-invasive techniques are less precise, and they cover only small regions with sufficient accuracy. CONCLUSIONS: Taking into account which type of accuracy is clinically relevant and that the whole skull does not always need to be covered with the greatest possible accuracy, all the described techniques have their indications. The simpler and less invasive techniques can spare time, decrease costs, and harm patient. A decision tree is presented to the reader.

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The Application Accuracy of Stereotactic Frames

Cited by 150 publications

References 22 publications

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Frame-based stereotaxy in a frameless era: current capabilities, relative role, and the positive- and negative predictive values of blood through the needle

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

Registration for computer-navigated surgery in edentulous patients: A problem-based decision concept

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