Stereotactic methodology is employed in a narrow range of neurosurgical procedures due to the difficulty encountered in using mechanical three dimensional digitizers.To extend the use of stereotaxy to all intracranial surgery, a system employing an infrared optical digitizer to track neurosurgical instruments during intracranial surgery has been developed.The system allows the indication of position using either CT, MRI, or PET scans on a display with three orthogonal views corresponding to axial, coronal, and sagittal reconstructions. The system consists of emitters attached to the clamp securing the patient's head, hand held instruments, a camera array, and a computer display. The surgical instrument, which can be of any type, and base ring are equipped with light emitting diodes tracked by the camera array suspended over the surgical field. By calculating the position of the patient's head and the surgical instrument, a three dimensional indication of position can be displayed on a graphics workstation. By using small markers noninvasively secured to a skull cap during imaging, the system avoids use of any stereotactic frame fixed to the head.We will present our experience with the system during 100 frameless procedures. The positional error of localization is less than 1 mm. The average length of stay for individuals undergoing craniotomy with this device was 3.0 days, compared to an average length of stay of 6 days using conventional neurosurgical techniques.There were no increased postoperative deficits, in spite of many of the tumors being located in "nonresectable" areas.The method of localization can be employed with a variety of instruments, including ultrasound probes, microscopes, and endoscopes. This system, by increasing the precision with which intracranial lesions can be approached, extends the benefits of stereotactic surgery to all intracranial procedures.
IntroductionProgress in surgery has always trailed the ability to visualize anatomy. One of the earliest surgeons, Ambrose Pare, would not have been able to make his advances without the visualization of the body's internal structure by Vesalius. With each advance in visualization, there has followed an advance in the art of surgery. 78 / SP1E Vol. 2132 0819414274/94/$6.OO Downloaded From: http://proceedings.spiedigitallibrary.org/ on 07/04/2016 Terms of Use: http://spiedigitallibrary.org/ss/TermsOfUse.aspx
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