title: Clinical introduction of an adjustable rigid instrument holder for frameless stereotactic interventions.
abstract: Interactive image guidance is now in routine use for open neurosurgical procedures and has demonstrated patient benefits. However, freehand interactive guidance is not an appropriate replacement for the traditional frame-based stereotactic procedures of biopsy, electrode placement, and functional lesioning. These point-based procedures require precise target localization and direct instrument guidance to avoid collateral brain injury. To perform true frameless stereotactic procedures requires a guide that is also adjustable for positioning, lockable, and adaptable to multiple instruments. We describe such a device, which is employed for the guidance of biopsy needles, shunts, electrodes, and endoscopes during neuronavigation. The method of frameless stereotactic biopsy retrieval with an infrared-based neuronavigation system is described, clinical results are given, and further areas of application discussed.
authors.affiliation: Gough-Cooper Department of Neurological Surgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom. N.Dorward@ion.bpmf.ac.uk
authors.forename: N L
authors.initials: NL
authors.lastname: Dorward
authors.forename: O
authors.initials: O
authors.lastname: Alberti
authors.forename: A
authors.initials: A
authors.lastname: Dijkstra
authors.forename: J
authors.initials: J
authors.lastname: Buurman
authors.forename: N D
authors.initials: ND
authors.lastname: Kitchen
authors.forename: D G
authors.initials: DG
authors.lastname: Thomas
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000295:instrumentation* / Q000379:methods; D001932:Brain Neoplasms / Q000473:pathology* / Q000556:secondary; D003337:Corpus Callosum / Q000473:pathology; D005260:Female; D005910:Glioma / Q000473:pathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007259:Infrared Rays; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010296:Parietal Lobe / Q000473:pathology; D013238:Stereotaxic Techniques / Q000295:instrumentation*; D013702:Temporal Lobe / Q000473:pathology; D013788:Thalamus / Q000473:pathology