title: Flexibility of head positioning and head fixation provided by a novel system for non-invasive maxillary fixation and frameless stereotaxy: technical note.
abstract: OBJECTIVE
  The aim of this study was to demonstrate the flexibility in patient positioning and head fixation provided by a newly developed, minimally invasive upper jaw fixation device in combination with standard navigation software.
  
  
  METHODS
  The Vogele-Bale-Hohner (VBH) headholder and the Stereotactic Intervention and Planning Laboratory (SIP-Lab) Innsbruck reference frame, were applied in epilepsy surgery requiring stereotactic guidance. The system can be adapted to various positioning and instrument guidance requirements. Instrument holders can be fixed either to a base plate or directly to the mouthpiece. When used together with a head clamp and a stabilizing arm, there are no restrictions on patient positioning. When used with the non-invasive headholder, only the supine position is well-suited for use with the described guidance instrumentation. The system can also be used with the head placed on the horseshoe headholder without altering navigation support.
  
  
  CONCLUSIONS
  The VBH mouthpiece combined with an external registration frame is a flexible tool that permits patient positioning and neuronavigation with the head either fixed with a head clamp, or restrained non-invasively with a headholder, or not fixed at all. This might be advantageous within the context of epilepsy surgery.
authors: Clinical Department of Neurosurgery, Innsbruck Medical University, 6020 Innsbruck, Austria. martin.ortler@i-med.ac.at
authors: M
authors: M
authors: Ortler
authors: C
authors: C
authors: Unterhofer
authors: R
authors: R
authors: Bauer
authors: J
authors: J
authors: Dobesberger
authors: E
authors: E
authors: Trinka
authors: R
authors: R
authors: Bale
mesh_terms: D004827:Epilepsy / Q000601:surgery; D004867:Equipment Design; D006257:Head; D006801:Humans; D008437:Maxilla; D038361:Neuronavigation / Q000295:instrumentation* / Q000379:methods*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D016683:Supine Position; D013523:Surgical Equipment; D013525:Surgical Instruments