A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope

David W. Roberts Division of Neurosurgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, and Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire

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John W. Strohbehn Division of Neurosurgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, and Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire

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John F. Hatch Division of Neurosurgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, and Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire

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William Murray Division of Neurosurgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, and Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire

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Hans Kettenberger Division of Neurosurgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, and Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire

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✓ A computer-based system has been developed for the integration and display of computerized tomography (CT) image data in the operating microscope in the correct perspective without requiring a stereotaxic frame. Spatial registration of the CT image data is accomplished by determination of the position of the operating microscope as its focal point is brought to each of three CT-imaged fiducial markers on the scalp. Monitoring of subsequent microscope positions allows appropriate reformatting of CT data into a common coordinate system. The position of the freely moveable microscope is determined by a non-imaging ultrasonic range-finder consisting of three spark gaps attached to the microscope and three microphones on a rigid support in the operating room. Measurement of the acoustic impulse transit times from the spark gaps to the microphones enables calculation of those distances and unique determination of the microscope position. The CT data are reformatted into a plane and orientation corresponding to the microscope's focal plane or to a deeper parallel plane if required. This reformatted information is then projected into the optics of the operating microscope using a miniature cathode ray tube and a beam splitter. The operating surgeon sees the CT information (such as a tumor boundary) superimposed upon the operating field in proper position, orientation, and scale.

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  • 1.

    Hatch JF, , Roberts DW, & Strohbehn JW: Reference-display system for the integration of CT scanning and the operating microscope, in Kuklinski WS, & Ohley WJ (eds): Proceedings of the Eleventh Annual Northeast Bioengineering Conference. New York: Institute of Electrical and Electronics Engineers, 1985, pp 252254 Hatch JF, Roberts DW, Strohbehn JW: Reference-display system for the integration of CT scanning and the operating microscope, in Kuklinski WS, Ohley WJ (eds): Proceedings of the Eleventh Annual Northeast Bioengineering Conference. New York: Institute of Electrical and Electronics Engineers, 1985, pp 252–254

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  • 2.

    Jacques S, , Shelden CH, & McCann GD, et al: Computerized three-dimensional stereotaxic removal of small central nervous system lesions in patients. J Neurosurg 53:816820, 1980 Jacques S, Shelden CH, McCann GD, et al: Computerized three-dimensional stereotaxic removal of small central nervous system lesions in patients. J Neurosurg 53:816–820, 1980

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    Kelly PJ, , Alker GJ Jr, & Goerss S: Computer-assisted stereotactic laser microsurgery for the treatment of intracranial neoplasms. Neurosurgery 10:324331, 1982 Kelly PJ, Alker GJ Jr, Goerss S: Computer-assisted stereotactic laser microsurgery for the treatment of intracranial neoplasms. Neurosurgery 10:324–331, 1982

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  • 4.

    Kelly PJ, , Kall B, & Goerss S, et al: Precision resection of intra-axial CNS lesions by CT-based stereotactic craniotomy and computer monitored CO2 laser. Acta Neurochir 68:19, 1983 Kelly PJ, Kall B, Goerss S, et al: Precision resection of intra-axial CNS lesions by CT-based stereotactic craniotomy and computer monitored CO2 laser. Acta Neurochir 68:1–9, 1983

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  • 5.

    Shelden CH, , McCann G, & Jacques S, et al: Development of a computerized microstereotaxic method for localization and removal of minute CNS lesions under direct 3-D vision. Technical report. J Neurosurg 52:2127, 1980 Shelden CH, McCann G, Jacques S, et al: Development of a computerized microstereotaxic method for localization and removal of minute CNS lesions under direct 3-D vision. Technical report. J Neurosurg 52:21–27, 1980

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