title: A methodology designed to increase accuracy and safety in stereotactic brain surgery.
abstract: A series of technical tips and devices designed to increase accuracy and safety in stereotactic surgery are presented. We use stereotactic magnetic resonance imaging with three-dimensional magnetization-prepared rapid gradient-echo (MP-RAGE) imaging to minimize image distortion, and a three-dimensional stereotactic planning system for accurately registering three-dimensional space. We also developed several technical devices useful for stereotactic intracranial procedures; an applicator system attached to the frame which simulates the fiducial markers in order to keep the target at a suitable position in stereotactic space; a torque wrench to set the torque on the fixing pins to the frame reproducibly at 5 inch pounds in order to keep distortion of the frame to a minimum while maintaining secure fixation; an entry point marker to maintain the calculated trajectory angle; a straightening cannula to prevent the thermo-coagulation needle from bending; a microvascular Doppler and its holder to detect significant vessels and to know their precise depth in order to avoid vascular injury from thermocoagulation; a burr hole button device to secure depth electrode cables at the patient's skull.
authors.affiliation: Department of Neurological Surgery, Virginia Neurological Institute, University of Virginia, Charlottesville, USA.
authors.forename: T
authors.initials: T
authors.lastname: Kamiryo
authors.forename: T
authors.initials: T
authors.lastname: Jackson
authors.forename: E
authors.initials: E
authors.lastname: Laws
mesh_terms: D001921:Brain / Q000473:pathology / Q000601:surgery*; D004564:Electrocoagulation; D006801:Humans; D008279:Magnetic Resonance Imaging; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods; D011183:Postoperative Complications; D012886:Skull; D013238:Stereotaxic Techniques / Q000295:instrumentation* / Q000592:standards