Stereotactic surgery: open or closed?
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Humans↗
Biomedical subjects
D Leksell
Publications and source records attributed to D Leksell.
Image-guided stereotactic surgery: a 10-year evolutionary experience.
The recent revolution in medical imaging has demanded concurrent development of sophisticated and compatible stereotactic guiding devices in order to diagnose or treat mass lesions on the brain and disorders of cerebral physiology. Between July 1, 1979, and July 1, 1989, 1,006 patients underwent image-guided stereotactic surgery at the University of Pittsburgh. During this 10-year interval the first dedicated computed tomography stereotactic operating room and the first North American radiosurgical suite containing a 201 60Co source gamma knife were constructed. Early in our experience, 60.5% of the patients underwent diagnostic (biopsy) stereotactic surgery whereas, by 1988, 77.8% of the patients underwent therapeutic stereotactic surgery. At our institution, stereotactic surgery was performed last year in 257 patients, representing 19.9% of all neurosurgical operations. During the past 10 years, stereotactic surgery has developed an integral and definitive role in contemporary mainstream neurosurgery. Across the world stereotactic technology is now widely available. In the future increasing emphasis will be placed on therapy, image integration, computer software development, and new instrumentation designed to meet the evolving needs of neurological surgeons who demand safe, precise, and effective tools to explore the brain.
Biopsy↗
Stereotactic neurosurgery planning on a personal-computer-based work station.
Stereotactic surgery requires knowledge of cerebral structures derived from more than one image source. We have developed a PC-AT-based workstation that accepts patient images, made with the stereotactic frame in place, from CT, MRI, and DSA modalities. Reference markers on the frame are identified in the images to establish the coordinate geometry for each modality. Target points may be identified on each image type and trajectories of probe paths to these points defined. Targets identified on one set of images may be transferred automatically to other images of the same patient in order to guarantee a vessel-free path of approach to a target point deep within the brain. To date several hundred patients have had stereotactic surgery performed on the basis of plans using this system. Procedures included biopsy and aspiration of lesions, implantation of electrodes for the recording of deep EEG signals, and radiosurgical techniques. We present clinical examples of the use of this system in typical stereotactic neurosurgery procedures, address stereoscopic applications, and discuss the results of intermodality tests to establish the accuracy of the technique.
Angiography, Digital Subtraction↗
A new fixation device for the Leksell stereotaxic system. Technical note.
A device is presented that permits several applications for the Leksell stereotaxic system. The patient is fixed in this new system by means of a rectangular instrument that connects to the standard Leksell stereotaxic coordinate frame and maintains spatial orientation after the frame itself is removed. Specific uses for this device include stereotaxic radiosurgery and stereotaxic guidance during microsurgery. Other attractive features of this device are its capability of being precisely reapplied, its compatibility with both computerized tomography and magnetic resonance imaging, and the availability of an accessory device to adapt it for animal stereotaxis.
Humans↗
Stereotactic gamma irradiation of basilar artery in cat. Preliminary experiences.
Irradiation of the basilar artery of cats by stereotactic technique was performed with doses varying from 100 to 300 Gy in a gamma unit. Histologically, vascular lesions such as vacuolization, degeneration and desquamation of the endothelium and hyalinization and necrosis of the muscular coat predominated, whereas reparatory reactions were relatively sparse. Thrombosis was completely absent.
Animals↗