Clinical use of a frameless stereotactic arm: results of 325 cases

View More View Less
  • 1 Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ The viewing wand is a frameless stereotactic arm that can be used in conjunction with computerized tomography (CT) or magnetic resonance (MR) imaging to provide image-based intraoperative navigation. The authors report a series of 325 cases in which the viewing wand was used and evaluated for its utility, ease of integration into the standard surgical setup, reliability, and real-world accuracy. The use of the system was associated with minimal additional effort or time spent in setting up the procedure as long as a trained technician performed the data transfer and reconstruction. The viewing wand was used in 165 cases in conjunction with CT and 145 cases with MR imaging. The system was reliable, achieving a useful registration in 310 of 325 cases (95.4%). Fiducial-based registration was more accurate than an anatomical landmark—surface fit algorithm method of registration (mean 2.8 vs. 5.6 mm error, respectively, for CT; and mean 3.0 vs. 6.2 mm for MR imaging). The actual error of the system in estimating the position of the probe tip just after registration was judged by the operating surgeon to be less than 2 mm in 92% of MR imaging cases and in 82% of CT cases, between 2 and 5 mm in 7% of MR imaging and 17% of CT cases, and greater than 5 mm in less than 1% of MR imaging and 1.2% of CT cases. The accuracy of the system degraded during the operation, so that by the third evaluation the error was estimated to be less than 2 mm in 77% of MR imaging and 62% of CT cases.

Overall, the viewing wand was found to be reliable and accurate. This real-world accuracy was sufficient for a broad range of applications including glioma resection, cerebrospinal fluid shunting procedures, resection of small subcortical masses, and temporal lobe resection. The system is a useful navigational aid that allows a direct approach to intracranial pathology without the drawbacks of application and the limitations of a stereotactic frame.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Robert F. Spetzler, M.D., c/o Editorial Office, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013–4496.
  • 1.

    Adams L, , Krybus W, & Meyer-Ebrecht D, et al: Computer-assisted surgery. IEEE Comput Graph Appl 10:4351, 1990 Adams L, Krybus W, Meyer-Ebrecht D, et al: Computer-assisted surgery. IEEE Comput Graph Appl 10:43–51, 1990

    • Search Google Scholar
    • Export Citation
  • 2.

    Bakay RAE: Expert commentary on Guthrie and Adler: frameless stereotaxy. Perspect Neurol Surg 2:1619, 1991 Bakay RAE: Expert commentary on Guthrie and Adler: frameless stereotaxy. Perspect Neurol Surg 2:16–19, 1991

    • Search Google Scholar
    • Export Citation
  • 3.

    Barnett GH, , Kormos DW, & Steiner CP, et al: Intraoperative localization using an armless, frameless stereotactic wand. Technical note. J Neurosurg 78:510514, 1993 Barnett GH, Kormos DW, Steiner CP, et al: Intraoperative localization using an armless, frameless stereotactic wand. Technical note. J Neurosurg 78:510–514, 1993

    • Search Google Scholar
    • Export Citation
  • 4.

    Barnett GH, , Kormos DW, & Steiner CP, et al: Use of a frameless, armless stereotactic wand for brain tumor localization with two-dimensional and three-dimensional neuroimaging. Neurosurgery 33:674678, 1993 Barnett GH, Kormos DW, Steiner CP, et al: Use of a frameless, armless stereotactic wand for brain tumor localization with two-dimensional and three-dimensional neuroimaging. Neurosurgery 33:674–678, 1993

    • Search Google Scholar
    • Export Citation
  • 5.

    Brodwater BK, , Roberts DW, & Nakajima T, et al: Extracranial application of the frameless stereotactic operating microscope: experience with lumbar spine. Neurosurgery 32:209213, 1993 Brodwater BK, Roberts DW, Nakajima T, et al: Extracranial application of the frameless stereotactic operating microscope: experience with lumbar spine. Neurosurgery 32:209–213, 1993

    • Search Google Scholar
    • Export Citation
  • 6.

    Dante Alighieri: The Divine Comedy. Danbury, CT: Grolier, 1980, p 12 Dante Alighieri: The Divine Comedy. Danbury, CT: Grolier, 1980, p 12

    • Search Google Scholar
    • Export Citation
  • 7.

    Friets EM, , Strohbehn JW, & Hatch JF, et al: A frameless stereotaxic operating microscope for neurosurgery. IEEE Trans Biomed Eng 36:608617, 1989 Friets EM, Strohbehn JW, Hatch JF, et al: A frameless stereotaxic operating microscope for neurosurgery. IEEE Trans Biomed Eng 36:608–617, 1989

    • Search Google Scholar
    • Export Citation
  • 8.

    Galloway RL, & Maciunas RJ: Stereotactic neurosurgery. Crit Rev Biomed Eng 18:181205, 1990 Galloway RL, Maciunas RJ: Stereotactic neurosurgery. Crit Rev Biomed Eng 18:181–205, 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Galloway RL Jr, , Edwards CA II, & Lewis JT, et al: Image display and surgical visualization in interactive image-guided neurosurgery. Optic Eng 32:19551962, 1993 Galloway RL Jr, Edwards CA II, Lewis JT, et al: Image display and surgical visualization in interactive image-guided neurosurgery. Optic Eng 32:1955–1962, 1993

    • Search Google Scholar
    • Export Citation
  • 10.

    Galloway RL Jr, , Maciunas RJ, & Latimer JW: The accuracies of four stereotactic frame systems: an independent assessment. Biomed Instrum Technol 25:457460, 1991 Galloway RL Jr, Maciunas RJ, Latimer JW: The accuracies of four stereotactic frame systems: an independent assessment. Biomed Instrum Technol 25:457–460, 1991

    • Search Google Scholar
    • Export Citation
  • 11.

    Guthrie BL, & Adler JR Jr: Computer-assisted preoperative planning, interactive surgery, and frameless stereotaxy. Clin Neurosurg 38:112131, 1992 Guthrie BL, Adler JR Jr: Computer-assisted preoperative planning, interactive surgery, and frameless stereotaxy. Clin Neurosurg 38:112–131, 1992

    • Search Google Scholar
    • Export Citation
  • 12.

    Guthrie BL, & Adler JR Jr: Frameless stereotaxy: computer interactive neurosurgery. Perspect Neurol Surg 2:122, 1991 Guthrie BL, Adler JR Jr: Frameless stereotaxy: computer interactive neurosurgery. Perspect Neurol Surg 2:1–22, 1991

    • Search Google Scholar
    • Export Citation
  • 13.

    Kato A, , Yoshimine T, & Hayakawa T, et al: A frameless, armless navigational system for computer-assisted neurosurgery. Technical note. J Neurosurg 74:845849, 1991 Kato A, Yoshimine T, Hayakawa T, et al: A frameless, armless navigational system for computer-assisted neurosurgery. Technical note. J Neurosurg 74:845–849, 1991

    • Search Google Scholar
    • Export Citation
  • 14.

    Koivukangas J, , Louhisalmi Y, & Alakuijala J, et al: Ultrasound-controlled neuronavigator-guided brain surgery. J Neurosurg 79:3642, 1993 Koivukangas J, Louhisalmi Y, Alakuijala J, et al: Ultrasound-controlled neuronavigator-guided brain surgery. J Neurosurg 79:36–42, 1993

    • Search Google Scholar
    • Export Citation
  • 15.

    Kondziolka D, , Dempsey PK, & Lunsford LD, et al: A comparison between magnetic resonance imaging and computed tomography for stereotactic coordinate determination. Neurosurgery 30:402407, 1992 Kondziolka D, Dempsey PK, Lunsford LD, et al: A comparison between magnetic resonance imaging and computed tomography for stereotactic coordinate determination. Neurosurgery 30:402–407, 1992

    • Search Google Scholar
    • Export Citation
  • 16.

    Laborde G, , Gilsbach J, & Harders A, et al: Computer assisted localizer for planning of surgery and intra-operative orientation. Acta Neurochir 119:166170, 1992 Laborde G, Gilsbach J, Harders A, et al: Computer assisted localizer for planning of surgery and intra-operative orientation. Acta Neurochir 119:166–170, 1992

    • Search Google Scholar
    • Export Citation
  • 17.

    Laborde G, , Klimek L, & Harders A, et al: Frameless stereotactic drainage of intracranial abscesses. Surg Neurol 40:1621, 1993 Laborde G, Klimek L, Harders A, et al: Frameless stereotactic drainage of intracranial abscesses. Surg Neurol 40:16–21, 1993

    • Search Google Scholar
    • Export Citation
  • 18.

    Reinhardt HF, , Horstmann GA, & Gratzl O: Sonic stereometry in microsurgical procedures for deep-seated brain tumors and vascular malformations. Neurosurgery 32:5157, 1993 Reinhardt HF, Horstmann GA, Gratzl O: Sonic stereometry in microsurgical procedures for deep-seated brain tumors and vascular malformations. Neurosurgery 32:51–57, 1993

    • Search Google Scholar
    • Export Citation
  • 19.

    Roberts DW, , Strohbehn JW, & Hatch JF, et al: A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope. J Neurosurg 65:545549, 1986 Roberts DW, Strohbehn JW, Hatch JF, et al: A frameless stereotaxic integration of computerized tomographic imaging and the operating microscope. J Neurosurg 65:545–549, 1986

    • Search Google Scholar
    • Export Citation
  • 20.

    Spetzler RF, & Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476483, 1986 Spetzler RF, Martin NA: A proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483, 1986

    • Search Google Scholar
    • Export Citation
  • 21.

    Tan KK, , Grzeszczuk R, & Levin DN, et al: A frameless stereotactic approach to neurosurgical planning based on retrospective patient-image registration. Technical note. J Neurosurg 79:296303, 1993 Tan KK, Grzeszczuk R, Levin DN, et al: A frameless stereotactic approach to neurosurgical planning based on retrospective patient-image registration. Technical note. J Neurosurg 79:296–303, 1993

    • Search Google Scholar
    • Export Citation
  • 22.

    Watanabe E, , Mayanagi Y, & Kosugi Y, et al: Open surgery assisted by the neuronavigator, a stereotactic, articulated, sensitive arm. Neurosurgery 28:792800, 1991 Watanabe E, Mayanagi Y, Kosugi Y, et al: Open surgery assisted by the neuronavigator, a stereotactic, articulated, sensitive arm. Neurosurgery 28:792–800, 1991

    • Search Google Scholar
    • Export Citation
  • 23.

    Watanabe E, , Watanabe T, & Manaka S, et al: Three-dimensional digitizer (neuronavigator): new equipment for computer tomography-guided stereotaxic surgery. Surg Neurol 27:543547, 1987 Watanabe E, Watanabe T, Manaka S, et al: Three-dimensional digitizer (neuronavigator): new equipment for computer tomography-guided stereotaxic surgery. Surg Neurol 27:543–547, 1987

    • Search Google Scholar
    • Export Citation
  • 24.

    Zinreich SJ, , Tebo SA, & Long DM, et al: Frameless stereotaxic integration of CT imaging data: accuracy and initial applications. Radiology 188:735742, 1993 Zinreich SJ, Tebo SA, Long DM, et al: Frameless stereotaxic integration of CT imaging data: accuracy and initial applications. Radiology 188:735–742, 1993

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 566 138 14
Full Text Views 231 15 1
PDF Downloads 130 16 0
EPUB Downloads 0 0 0