Frameless stereotactic guidance for surgery of the upper cervical spine.
OBJECTIVE
The goal was to evaluate and describe the use of a frameless, computed tomography-guided, stereotactic technique in complex procedures involving the craniocervical junction.


METHODS
Eleven procedures, including transoral odontoid resection, posterior atlantoaxial fusion with transarticular C1-C2 screw fixation, and spinal tumor resection, were performed in the preceding 26 months. In each case, frameless stereotaxy was used to plan the incision, to define resection margins, and to determine the appropriate orientation of instrumentation.


RESULTS
There were no intraoperative complications noted. Each patient underwent adequate resection of the pathological lesion and satisfactory placement of instrumentation. The stereotactic system provided detailed anatomic visualization, which increased the confidence of the surgeon during the procedure. The system limited the need for extensive surgical exposure, reduced fluoroscopy time, and decreased the risk of neurovascular injury.


CONCLUSIONS
Frameless stereotaxy provided the surgeon with intraoperative information regarding the extent of bone and soft tissue resection. It provided a multidimensional view of anatomic relationships in the operative field, which significantly increased surgical accuracy and safety.
Welch
W C
WC
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA.
Subach
B R
BR
Pollack
I F
IF
Jacobs
G B
GB
D000328:Adult; D001268:Atlanto-Axial Joint / Q000293:injuries / Q000601:surgery; D002574:Cervical Vertebrae / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*