title: Use of a frameless, armless stereotactic wand for brain tumor localization with two-dimensional and three-dimensional neuroimaging.
abstract: Preliminary experience with a frameless, armless stereotactic localization system in brain tumor surgery is presented. The localizing wand emits ultrasonic pulses that are detected by a table-mounted array of microphones--with triangulation of the emitter positions. The wand tip and trajectory are determined by proprietary computer software. Real-time display of this information is presented in multiple, two-dimensional or three-dimensional displays. Forty-eight patients underwent 52 craniotomies for brain tumors. The wand was used to assist in placing a minimal craniotomy in 48 cases, to determine the tumor/brain interface in 27 cases, to localize subcortical tumors in 14 cases, and to correlate the physiological mapping with the surface anatomy in 5 cases. In 12 instances, the wand was used in conjunction with frame stereotaxy and found to be comparable or superior. Triplanar (coronal, sagittal, transverse) two-dimensional images provided sufficient information for the detection of tumor boundaries but proved difficult to use to access a subcortical lesion; two-dimensional or three-dimensional images along the localization axis were more helpful. Frameless stereotaxy with this sonic wand system proved to be a useful adjunct to open-tumor biopsy or resection.
authors.affiliation: Center for Computer-assisted Neurosurgery, Cleveland Clinic Foundation, Ohio.
authors.forename: G H
authors.initials: GH
authors.lastname: Barnett
authors.forename: D W
authors.initials: DW
authors.lastname: Kormos
authors.forename: C P
authors.initials: CP
authors.lastname: Steiner
authors.forename: J
authors.initials: J
authors.lastname: Weisenberger
mesh_terms: D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000295:instrumentation; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D015173:Supratentorial Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013523:Surgical Equipment; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*