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M. Sean Grady, Matthew A. Howard III, Ralph G. Dacey Jr., Walter Blume, Michael Lawson, Peter Werp, and Rogers C. Ritter

it with the designated path, and adjusts magnetic guidance accordingly. Images are updated once per second, and adjustments to magnetic guidance are made every 3 mm. The surgeon's interface uses modified software supplied with the Stealth frameless stereotaxis system. Advances in computer hardware have provided sufficient speed and storage in the relatively simple computer systems incorporated in the MSS. Intraoperative imaging provided a substantial challenge. Most fluoroscopes rely on electrostatic image intensifiers, which are highly sensitive to magnetic fields

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Marwan I. Hariz and A. Tommy Bergenheim

V entriculography is still considered the method of choice for calculation of target coordinates in functional stereotaxis; computerized tomography (CT) when performed, is a complement to, not a substitute for, ventriculography. 10, 13, 20, 22, 29, 31 However, several techniques for CT-guided functional stereotaxis have been reported. They require surgery to be performed either inside the CT gantry 26 or in the surgical theater directly after the CT study, usually without a possibility of removing the frame between performance of the CT study and surgery. 1

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Charles G. diPierro, Paul C. Francel, Theodore R. Jackson, Toshifumi Kamiryo, and Edward R. Laws Jr.

imaging can create nearly distortion-free images and accurate coordinates. A major cause of magnetic distortion in earlier studies using MR imaging for stereotaxis was the two-dimensional (2-D) imaging technique. In 2-D MR imaging, several slices are acquired sequentially to image a 3-D volume. With the 3-D MR imaging technique used in our study, the whole image field of view is excited at once, and only weak slice selection is used so that the well-known “potato chip” and “bowtie” effects seen with 2-D MR imaging are no longer an issue. In 3-D MR imaging, therefore

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Walter A. Hall, Haiying Liu, Alastair J. Martin, Robert E. MAxwell, and Charles L. Truwit

positions based on shift of the ventricles as seen on pneumoencephalography or ventriculography. 9 Later in that decade, MR imaging became an important aid to neurosurgeons because of its ability to show the brain in multiple projections and its exquisite anatomical detail. 8 This modality was immediately incorporated into stereotaxis for both brain biopsy procedures and volumetric tumor resections. Frameless stereotactic systems have been under development and implementation since the mid-1980s. These systems require preoperative imaging that is oriented to a

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Eric M. Gabriel and Blaine S. Nashold Jr

intracranial neurosurgical procedures. Spinal Cord Stereotaxy Stereotaxis has not been limited in its use to intracranial operations. Interestingly, long before Horsley and Clarke's 17 landmark paper appeared in Brain in 1908, the first attempts at localization of specific points in the central nervous system began with experimental studies of the spinal cord. The earliest documented use of the principle of guiding devices for directing probes to their targets appeared in the work of Dittmar 6 in 1873. 1 While working at The Physiological Institute of Professor

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Jeffrey V. Rosenfeld, David Wallace, Geoffrey L. Klug, and Andrew Danks

O pen skull-base surgery for tumors of the clivus region is complex and prolonged, and carries significant risk of morbidity. 1, 8, 9, 11 Computerized tomography (CT)-guided transnasal stereotaxis provides an accurate and safe alternative approach to this region when tissue diagnosis alone is required. We describe the technique and present the first case of a transnasal stereotactic biopsy of a clivus lesion reported in the literature. Case Report This 12-year-old boy presented with a 4-week history of diplopia on right lateral gaze. Examination

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Douglas S. Cohen, Jonathan H. Lustgarten, Erik Miller, Alexander G. Khandji, and Robert R. Goodman

S tereotactic surgery has gained increasing acceptance over the past decades. Initial work with x-ray films has been supplanted by computerized tomography (CT) stereotaxis. The past 8 to 10 years have seen the emergence of magnetic resonance (MR) stereotaxis. 14 The increasing resolution and multiplanar capacity of MR stereotactic techniques have proved advantageous in facets of neurosurgery requiring exact anatomical localization, such as functional neurosurgery, 5, 6, 11, 18, 30 implantation of depth electrodes, 16, 17, 25, 29 and tumor surgery. 2, 7

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Demitre Serletis and T. Glenn Pait

ultimately paved the way for modern stereotaxy. 19 The term “stereotaxis” was originally derived by Horsley and Clarke, referring to the Greek stereos (meaning “solid”) and taxis (meaning “ordered” or “organized”). 19 , 49 The Horsley-Clarke frame allowed for strategic direction of an electrode into cortical and subcortical structures, with guidance based on the Cartesian coordinate system. It eventually served as the basis for a modification by the Canadian neuroanatomist and neurophysiologist, Aubrey Mussen (1873–1975) in 1918, who developed it for human use. 4 , 47

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Cole A. Giller, Patrick Mornet, and Jean-François Moreau

. 63 , 72 We describe the stereotactic method of Contremoulins, its origins from techniques of art, and its similarity to modern stereotaxis. We discuss how stereotactic ideas invented late in the 19th century to locate foreign objects became forgotten before the reinvention of stereotaxis 50 years later. Gaston Contremoulins: Early Years and Training Contremoulins was born in Rouen, France, in 1869. His father was a respected locksmith, and his grandfather was a skilled mechanic who serviced some of the first locomotives. The family tradition of precision mechanical

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