By D. Andries Bosch, Douwe Buiter
Various textbooks on stereotactic neurosurgery were released over the last few years (Riechert 1980, Schaltenbrand and Walker 1982, Spiegel 1982), them all facing practical stereo strategies because the significant topic within the box. Diagnostic and healing stereotactic interventions are just in short defined, while localization options should not but pointed out. due to the fact that 1980, besides the fact that, more and more stories has been released on CT guided and desktop monitored stereotactic performances which allow the health care professional to mix diagnostic and healing efforts in a single consultation. With fresh development in scanning concepts, together with excessive solution CT, NMR, and puppy imaging of the mind, it has turn into attainable to review and localize any mind niche. With the concomitant advances in machine expertise, third-dimensional reconstruction of deep seated lesions in stereotactic house is feasible and how is open for mixed surgical procedure with stereotactic precision and computing device guided open resection. this sort of open surgical procedure in stereotactic area is already being built in a few facilities through microsurgical, fiberoptic, and laser beam instrumentation. With those advances stereotactic concepts will quickly turn into in tegrated into scientific neurosurgery. Stereotactics has develop into a metho dology which allows the health care provider to assault deep seated and subcortical small tumors. Neurosurgeons could abandon healing nihilism, nonetheless often noticeable in glioma therapy, within the close to destiny while stereotactic resection should be possible and last tumor cells could be killed by means of adjuvant therapy modalities nonetheless in development.
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Extra resources for Stereotactic Techniques in Clinical Neurosurgery
There is no need for mathematical calculations and no special X-ray equipment is necessary. g. in posterior percutaneous trigeminal or in pontine tractotomy). Aiming devices for different approaches include a transverse quadrant and a vertical quadrant, the use of each being dependent on the type of surgery wanted. Xray pictures during the operation can be made of the target area as easy as with Leksell's system. g. multiple epilepsy electrode implantation) a lateral micropositioner is available, which after removal of the transverse or vertical quadrant can be placed at the same coordinates.
To abandon X-ray enlargement, Talairach (1955) and Schaltenbrand (Riechert and Mundinger 1959) introduced teleradiography, which is based on an infInite focus-object distance (at least 6 metres). This technique, however, is expensive and needs special building facilities. Most of the stereotactic centers therefore accept a constant enlargement that is standardized and make proportional correction by simple calculation (Spiegel and Wycis 1952) or by a special projection technique (Leksell 1957).
17. Correction for midline shift of instrument. Illustrated with the lateral arrangement as seen from above. a) Shows midline shift of midsagittal plane of instrument (M) regarding midsagittal plane of brain (M]). When the planes run (almost) parallel to each other this is acceptable, but needs correction. Shift to the right (as illustrated) leads to a z-coordinate, which is the true z of the target + the error (e) with a target lying in the left hemisphere, and - the error with a target lying in the right hemisphere.