Frameless stereotaxy with scalp-applied fiducial markers for brain biopsy procedures: experience in 218 cases

View More View Less
  • 1 Center for Computer-Assisted Neurosurgery, The Brain Tumor and Neuro-oncology Center, and The Cancer Center, The Cleveland Clinic Foundation, Cleveland, Ohio
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

Object. The goal of this study was to develop and assess the use and limitations of performing brain biopsy procedures by using image-guided surgical navigation systems (SNSs; that is, frameless stereotactic systems) with scalp-applied fiducial markers.

Methods. Two hundred eighteen percutaneous brain biopsies were performed in 213 patients by using a frameless stereotactic SNS that operated with either sonic or optical digitizer technology and scalp-applied fiducial markers for the purpose of registering image space with operating room space. Common neurosurgical and stereotactic instrumentation was adapted for use with a localizing wand, and recently developed target and trajectory guidance software was used.

Eight (3.7%) of the 218 biopsy specimens were nondiagnostic; five of these (2.4%) were obtained during procedures in 208 supratentorial lesions and three were obtained during procedures in 10 infratentorial lesions (30%; p < 0.001). Complications related to the biopsy procedure occurred in eight patients (seven of whom had supratentorial lesions and one of whom had an infratentorial lesion, p > 0.25). Five complications were intracerebral hemorrhages (two of which required craniotomy), two were infections, and one was wound breakdown after instillation of intratumoral carmustine following biopsy. There were only three cases of sustained morbidity, and there were two deaths and one delayed deterioration due to disease progression.

Two surgeons performed the majority of the procedures (193 cases). The three surgeons who performed more than 10 biopsies had complication rates lower than 5%, whereas two of the remaining four surgeons had complication rates greater than 10% (p = 0.15).

Twenty-three additional procedures were performed in conjunction with the biopsies: nine brachytherapies; five computer-assisted endoscopies; four cyst aspirations; two instillations of carmustine; two placements of Ommaya reservoirs; and one craniotomy.

Conclusions. Brain biopsy procedures in which guidance is provided by a frameless stereotactic SNS with scalp-applied fiducial markers represents a safe and effective alternative to frame-based stereotactic procedures for supratentorial lesions. There were comparable low rates of morbidity and a high degree of diagnostic success. Strategies for performing posterior fossa biopsies are suggested.

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: Gene H. Barnett, M.D., Department of Neurological Surgery—S80, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195. email: barnett@neus.ccf.org.
  • 1.

    Apuzzo MLJ, , Chandrasoma PT, & Cohen D, et al: Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses. Neurosurgery 20:930937, 1987 Apuzzo MLJ, Chandrasoma PT, Cohen D, et al: Computed imaging stereotaxy: experience and perspective related to 500 procedures applied to brain masses. Neurosurgery 20:930–937, 1987

    • Search Google Scholar
    • Export Citation
  • 2.

    Apuzzo MLJ, & Sabshin JK: Computed tomographic guidance stereotaxis in the management of intracranial mass lesions. Neurosurgery 12:277285, 1983 Apuzzo MLJ, Sabshin JK: Computed tomographic guidance stereotaxis in the management of intracranial mass lesions. Neurosurgery 12:277–285, 1983

    • Search Google Scholar
    • Export Citation
  • 3.

    Barnett GH, , Kormos DW, & Steiner CP, et al: Frameless stereotaxy using a sonic digitizing wand: development and adaptation to the Picker ViStar Medical Imaging System, in Maciunas RJ (ed): Interactive Image-Guided Neurosurgery. Park Ridge, Ill: American Association of Neurological Surgeons, 1993, pp 113119 Barnett GH, Kormos DW, Steiner CP, et al: Frameless stereotaxy using a sonic digitizing wand: development and adaptation to the Picker ViStar Medical Imaging System, in Maciunas RJ (ed): Interactive Image-Guided Neurosurgery. Park Ridge, Ill: American Association of Neurological Surgeons, 1993, pp 113–119

    • Search Google Scholar
    • Export Citation
  • 4.

    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
  • 5.

    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
  • 6.

    Barnett GH, , McKenzie RL, & Ramos L, et al: Nonvolumetric stereotaxy-assisted craniotomy. Results in 50 consecutive cases. Stereotact Funct Neurosurg 61:8095, 1993 Barnett GH, McKenzie RL, Ramos L, et al: Nonvolumetric stereotaxy-assisted craniotomy. Results in 50 consecutive cases. Stereotact Funct Neurosurg 61:80–95, 1993

    • Search Google Scholar
    • Export Citation
  • 7.

    Barnett GH, & Miller DW: Brain biopsy and related procedures, in Barnett GH, , Roberts DW, & Maciunas RJ (eds): Image-Guided Neurosurgery: Clinical Applications of Surgical Navigation. St. Louis: Quality Medical Publishers, 1998, pp 181191 Barnett GH, Miller DW: Brain biopsy and related procedures, in Barnett GH, Roberts DW, Maciunas RJ (eds): Image-Guided Neurosurgery: Clinical Applications of Surgical Navigation. St. Louis: Quality Medical Publishers, 1998, pp 181–191

    • Search Google Scholar
    • Export Citation
  • 8.

    Barnett GH, , Steiner CP, & Weisenberger J: Target and trajectory guidance for interactive surgical navigation systems. Stereotact Funct Neurosurg 66:9195, 1996 Barnett GH, Steiner CP, Weisenberger J: Target and trajectory guidance for interactive surgical navigation systems. Stereotact Funct Neurosurg 66:91–95, 1996

    • Search Google Scholar
    • Export Citation
  • 9.

    Berger MS: Ultrasound-guided stereotaxic biopsy using a new apparatus. J Neurosurg 65:550554, 1986 Berger MS: Ultrasound-guided stereotaxic biopsy using a new apparatus. J Neurosurg 65:550–554, 1986

    • Search Google Scholar
    • Export Citation
  • 10.

    Blaauw G, & Braakman R: Pitfalls in diagnostic stereotactic brain surgery. Acta Neurochir Suppl 42:161165, 1988 Blaauw G, Braakman R: Pitfalls in diagnostic stereotactic brain surgery. Acta Neurochir Suppl 42:161–165, 1988

    • Search Google Scholar
    • Export Citation
  • 11.

    Bouvier G, , Couillard P, & Leger SL, et al: Stereotactic biopsy of cerebral space-occupying lesions. Appl Neurophysiol 46:227230, 1983 Bouvier G, Couillard P, Leger SL, et al: Stereotactic biopsy of cerebral space-occupying lesions. Appl Neurophysiol 46:227–230, 1983

    • Search Google Scholar
    • Export Citation
  • 12.

    Brown RA: A computerized tomography-computer graphics approach to stereotaxic localization. J Neurosurg 50:715720, 1979 Brown RA: A computerized tomography-computer graphics approach to stereotaxic localization. J Neurosurg 50:715–720, 1979

    • Search Google Scholar
    • Export Citation
  • 13.

    Brown RA, , Roberts TS, & Osborn AG: Stereotaxic frame and computer software for CT-directed neurosurgical localization. Invest Radiol 15:308312, 1980 Brown RA, Roberts TS, Osborn AG: Stereotaxic frame and computer software for CT-directed neurosurgical localization. Invest Radiol 15:308–312, 1980

    • Search Google Scholar
    • Export Citation
  • 14.

    Chandrasoma PT, , Smith MM, & Apuzzo MLJ: Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen. Neurosurgery 24:160165, 1989 Chandrasoma PT, Smith MM, Apuzzo MLJ: Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen. Neurosurgery 24:160–165, 1989

    • Search Google Scholar
    • Export Citation
  • 15.

    Colombo F, , Casentini L, & Zanusso M, et al: Validity of stereotactic biopsy as a diagnostic tool. Acta Neurochir Suppl 42:152156, 1988 Colombo F, Casentini L, Zanusso M, et al: Validity of stereotactic biopsy as a diagnostic tool. Acta Neurochir Suppl 42:152–156, 1988

    • Search Google Scholar
    • Export Citation
  • 16.

    Di Lorenzo N, , Esposito V, & Lunardi P, et al: A comparison of computerized tomography-guided stereotactic and ultrasoundguided techniques for brain biopsy. J Neurosurg 75:763765, 1991 Di Lorenzo N, Esposito V, Lunardi P, et al: A comparison of computerized tomography-guided stereotactic and ultrasoundguided techniques for brain biopsy. J Neurosurg 75:763–765, 1991

    • Search Google Scholar
    • Export Citation
  • 17.

    Drake JM, , Rutka JT, & Hoffman HJ: ISG Viewing Wand system. Neurosurgery 34:10941097, 1994 Drake JM, Rutka JT, Hoffman HJ: ISG Viewing Wand system. Neurosurgery 34:1094–1097, 1994

    • Search Google Scholar
    • Export Citation
  • 18.

    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
  • 19.

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

    • Search Google Scholar
    • Export Citation
  • 20.

    Germano IM, & Queenan JV: Clinical experience with intracranial brain needle biopsy using frameless surgical navigation. Comput Aid Surg 3:3339, 1998 Germano IM, Queenan JV: Clinical experience with intracranial brain needle biopsy using frameless surgical navigation. Comput Aid Surg 3:33–39, 1998

    • Search Google Scholar
    • Export Citation
  • 21.

    Goldstein S, , Gumerlock MK, & Neuwelt EA: Comparison of CTguided and stereotaxic cranial diagnostic needle biopsies. J Neurosurg 67:341348, 1987 Goldstein S, Gumerlock MK, Neuwelt EA: Comparison of CTguided and stereotaxic cranial diagnostic needle biopsies. J Neurosurg 67:341–348, 1987

    • Search Google Scholar
    • Export Citation
  • 22.

    Gomez H, , Barnett GH, & Estes ML, et al: Stereotactic and computer-assisted neurosurgery at the Cleveland Clinic: review of 501 consecutive cases. Cleve Clin J Med 60:399410, 1993 Gomez H, Barnett GH, Estes ML, et al: Stereotactic and computer-assisted neurosurgery at the Cleveland Clinic: review of 501 consecutive cases. Cleve Clin J Med 60:399–410, 1993

    • Search Google Scholar
    • Export Citation
  • 23.

    Greenblatt SH, , Rayport M, & Savolaine ER, et al: Computed tomography-guided intracranial biopsy and cyst aspiration. Neurosurgery 11:589598, 1982 Greenblatt SH, Rayport M, Savolaine ER, et al: Computed tomography-guided intracranial biopsy and cyst aspiration. Neurosurgery 11:589–598, 1982

    • Search Google Scholar
    • Export Citation
  • 24.

    Guthrie BL, & Adler JR: Frameless stereotaxy: computer interactive neurosurgery, in Barrow DL (ed): Perspectives in Neurological Surgery. St. Louis: Quality Medical Publishing, 1991, Vol 2, pp 119 Guthrie BL, Adler JR: Frameless stereotaxy: computer interactive neurosurgery, in Barrow DL (ed): Perspectives in Neurological Surgery. St. Louis: Quality Medical Publishing, 1991, Vol 2, pp 1–19

    • Search Google Scholar
    • Export Citation
  • 25.

    Hahn JF, , Levy WJ, & Weinstein MJ: Needle biopsy of intracranial lesions guided by computerized tomography. Neurosurgery 5:1115, 1979 Hahn JF, Levy WJ, Weinstein MJ: Needle biopsy of intracranial lesions guided by computerized tomography. Neurosurgery 5:11–15, 1979

    • Search Google Scholar
    • Export Citation
  • 26.

    Hassenbusch SJ, , Pillay PK, & Barnett GH: Radiofrequency cingulotomy for intractable cancer pain using stereotaxis guided by magnetic resonance imaging. Neurosurgery 27:220223, 1990 Hassenbusch SJ, Pillay PK, Barnett GH: Radiofrequency cingulotomy for intractable cancer pain using stereotaxis guided by magnetic resonance imaging. Neurosurgery 27:220–223, 1990

    • Search Google Scholar
    • Export Citation
  • 27.

    Heilbrun MP, , Roberts TS, & Apuzzo MLJ, et al: Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotactic guidance system. J Neurosurg 59:217222, 1983 Heilbrun MP, Roberts TS, Apuzzo MLJ, et al: Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotactic guidance system. J Neurosurg 59:217–222, 1983

    • Search Google Scholar
    • Export Citation
  • 28.

    Hirato M, , Watanabe K, & Takahashi A, et al: Use of a frameless isocentric stereotactic system (NEURO-SAT) combined with intraoperative microrecording. Stereotact Funct Neurosurg 63:8083, 1994 Hirato M, Watanabe K, Takahashi A, et al: Use of a frameless isocentric stereotactic system (NEURO-SAT) combined with intraoperative microrecording. Stereotact Funct Neurosurg 63:80–83, 1994

    • Search Google Scholar
    • Export Citation
  • 29.

    James HE, , Wells M, & Alksne JF, et al: Needle biopsy under computerized tomographic control: a method for tissue diagnosis in intracranial lesions. Neurosurgery 5:671674, 1979 James HE, Wells M, Alksne JF, et al: Needle biopsy under computerized tomographic control: a method for tissue diagnosis in intracranial lesions. Neurosurgery 5:671–674, 1979

    • Search Google Scholar
    • Export Citation
  • 30.

    Karlsson B, , Ericson K, & Kihlström L, et al: Tumor seeding following stereotactic biopsy of brain metastases. Report of two cases. J Neurosurg 87:327330, 1997 Karlsson B, Ericson K, Kihlström L, et al: Tumor seeding following stereotactic biopsy of brain metastases. Report of two cases. J Neurosurg 87:327–330, 1997

    • Search Google Scholar
    • Export Citation
  • 31.

    Kelly PJ: Computer-assisted stereotaxis: new approaches for the management of intracranial intra-axial tumors. Neurology 36:535541, 1986 Kelly PJ: Computer-assisted stereotaxis: new approaches for the management of intracranial intra-axial tumors. Neurology 36:535–541, 1986

    • Search Google Scholar
    • Export Citation
  • 32.

    Kelly PJ: Tumor Stereotaxis. Philadelphia: WB Saunders, 1991, pp 6687 Kelly PJ: Tumor Stereotaxis. Philadelphia: WB Saunders, 1991, pp 66–87

    • Search Google Scholar
    • Export Citation
  • 33.

    Kelly PJ: Tumor Stereotaxis. Philadelphia: WB Saunders, 1991, pp 88121 Kelly PJ: Tumor Stereotaxis. Philadelphia: WB Saunders, 1991, pp 88–121

    • Search Google Scholar
    • Export Citation
  • 34.

    Kelly PJ: Tumor Stereotaxis. Philadelphia: WB Saunders, 1991, pp 183223 Kelly PJ: Tumor Stereotaxis. Philadelphia: WB Saunders, 1991, pp 183–223

    • Search Google Scholar
    • Export Citation
  • 35.

    Kelly PJ: Tumor Stereotaxis. Philadelphia: WB Saunders, 1991, pp 268295 Kelly PJ: Tumor Stereotaxis. Philadelphia: WB Saunders, 1991, pp 268–295

    • Search Google Scholar
    • Export Citation
  • 36.

    Kelly PJ: Volumetric stereotactic surgical resection of intraaxial brain mass lesions. Mayo Clin Proc 63:11861198, 1988 Kelly PJ: Volumetric stereotactic surgical resection of intraaxial brain mass lesions. Mayo Clin Proc 63:1186–1198, 1988

    • Search Google Scholar
    • Export Citation
  • 37.

    Kelly PJ, , Ahlskog JE, & Goerss SJ, et al: Computer-assisted stereotactic ventralis lateralis thalamotomy with microelectrode recording control in patients with Parkinson's disease. Mayo Clin Proc 62:655664, 1987 Kelly PJ, Ahlskog JE, Goerss SJ, et al: Computer-assisted stereotactic ventralis lateralis thalamotomy with microelectrode recording control in patients with Parkinson's disease. Mayo Clin Proc 62:655–664, 1987

    • Search Google Scholar
    • Export Citation
  • 38.

    Kelly PJ, , Kall BA, & Goerss SJ: Computer-interactive stereotactic resection of deep-seated and centrally located intraaxial brain lesions. Appl Neurophysiol 50:107114, 1987 Kelly PJ, Kall BA, Goerss SJ: Computer-interactive stereotactic resection of deep-seated and centrally located intraaxial brain lesions. Appl Neurophysiol 50:107–114, 1987

    • Search Google Scholar
    • Export Citation
  • 39.

    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
  • 40.

    Lee T, , Kenny BG, & Hitchock ER, et al: Supratentorial masses: stereotactic or freehand biopsy. Br J Neurosurg 5:331338, 1991 Lee T, Kenny BG, Hitchock ER, et al: Supratentorial masses: stereotactic or freehand biopsy. Br J Neurosurg 5:331–338, 1991

    • Search Google Scholar
    • Export Citation
  • 41.

    Lobato RD, , Rivas JJ, & Cabello A, et al: Stereotactic biopsy of brain lesions visualized with computed tomography. Appl Neurophysiol 45:426430, 1982 Lobato RD, Rivas JJ, Cabello A, et al: Stereotactic biopsy of brain lesions visualized with computed tomography. Appl Neurophysiol 45:426–430, 1982

    • Search Google Scholar
    • Export Citation
  • 42.

    Lunsford LD, , Latchaw RE, & Vries JK: Stereotactic implantation of deep brain electrodes using computed tomography. Neurosurgery 13:280286, 1983 Lunsford LD, Latchaw RE, Vries JK: Stereotactic implantation of deep brain electrodes using computed tomography. Neurosurgery 13:280–286, 1983

    • Search Google Scholar
    • Export Citation
  • 43.

    Lunsford LD, & Martinez AJ: Stereotactic exploration of the brain in the era of computed tomography. Surg Neurol 22:222230, 1984 Lunsford LD, Martinez AJ: Stereotactic exploration of the brain in the era of computed tomography. Surg Neurol 22:222–230, 1984

    • Search Google Scholar
    • Export Citation
  • 44.

    Maciunas RJ, , Galloway RL Jr, & Fitzpatrick JM, et al: A universal system for interactive image-directed neurosurgery. Stereotact Funct Neurosurg 58:108113, 1992 Maciunas RJ, Galloway RL Jr, Fitzpatrick JM, et al: A universal system for interactive image-directed neurosurgery. Stereotact Funct Neurosurg 58:108–113, 1992

    • Search Google Scholar
    • Export Citation
  • 45.

    Maciunas RJ, , Galloway RL Jr, & Latimer JW: The application accuracy of stereotactic frames. Neurosurgery 35:682695, 1994 Maciunas RJ, Galloway RL Jr, Latimer JW: The application accuracy of stereotactic frames. Neurosurgery 35:682–695, 1994

    • Search Google Scholar
    • Export Citation
  • 46.

    Moran CJ, , Naidich TP, & Marchoski JA: CT-guided needle placement in the central nervous system: results in 146 consecutive patients. AJR 143:861868, 1984 Moran CJ, Naidich TP, Marchoski JA: CT-guided needle placement in the central nervous system: results in 146 consecutive patients. AJR 143:861–868, 1984

    • Search Google Scholar
    • Export Citation
  • 47.

    Munari C, , Rosler J Jr, & Musolino A, et al: Differential diagnosis between tumoural and non-tumoural intracranial lesions in children: a stereotactic approach. Acta Neurochir Suppl 46:7578, 1989 Munari C, Rosler J Jr, Musolino A, et al: Differential diagnosis between tumoural and non-tumoural intracranial lesions in children: a stereotactic approach. Acta Neurochir Suppl 46:75–78, 1989

    • Search Google Scholar
    • Export Citation
  • 48.

    Mundinger F: CT stereotactic biopsy for optimizing the therapy of intracranial processes. Acta Neurochir Suppl 35:7074, 1985 Mundinger F: CT stereotactic biopsy for optimizing the therapy of intracranial processes. Acta Neurochir Suppl 35:70–74, 1985

    • Search Google Scholar
    • Export Citation
  • 49.

    Niizuma H, , Otsuki T, & Yonemitsu T, et al: Experiences with CTguided stereotaxic biopsies in 121 cases. Acta Neurochir Suppl 42:157160, 1988 Niizuma H, Otsuki T, Yonemitsu T, et al: Experiences with CTguided stereotaxic biopsies in 121 cases. Acta Neurochir Suppl 42:157–160, 1988

    • Search Google Scholar
    • Export Citation
  • 50.

    Ostertag CB, , Mennel HD, & Kiessling M: Stereotactic biopsy of brain tumors. Surg Neurol 14:275283, 1980 Ostertag CB, Mennel HD, Kiessling M: Stereotactic biopsy of brain tumors. Surg Neurol 14:275–283, 1980

    • Search Google Scholar
    • Export Citation
  • 51.

    Pillay PK, , Barnett G, & Awad I: MRI-guided stereotactic placement of depth electrodes in temporal lobe epilepsy. Br J Neurosurg 6:4754, 1992 Pillay PK, Barnett G, Awad I: MRI-guided stereotactic placement of depth electrodes in temporal lobe epilepsy. Br J Neurosurg 6:47–54, 1992

    • Search Google Scholar
    • Export Citation
  • 52.

    Rhoten RLP, , Luciano MG, & Barnett GH: Computer-assisted endoscopy for neurosurgical procedures: technical note. Neurosurgery 40:632638, 1997 Rhoten RLP, Luciano MG, Barnett GH: Computer-assisted endoscopy for neurosurgical procedures: technical note. Neurosurgery 40:632–638, 1997

    • Search Google Scholar
    • Export Citation
  • 53.

    Roberts DW, , Strohbehn JW, & Friets EM, et al: The stereotactic operating microscope: accuracy refinement and clinical experience. Acta Neurochir Suppl 46:112114, 1989 Roberts DW, Strohbehn JW, Friets EM, et al: The stereotactic operating microscope: accuracy refinement and clinical experience. Acta Neurochir Suppl 46:112–114, 1989

    • Search Google Scholar
    • Export Citation
  • 54.

    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
  • 55.

    Rosenfeld JV, , Barnett GH, & Palmer J: Computed tomography guided stereotactic thalamotomy using the Brown-Roberts-Wells system for nonparkinsonian movement disorders. Technical note. Stereotact Funct Neurosurg 56:184192, 1991 Rosenfeld JV, Barnett GH, Palmer J: Computed tomography guided stereotactic thalamotomy using the Brown-Roberts-Wells system for nonparkinsonian movement disorders. Technical note. Stereotact Funct Neurosurg 56:184–192, 1991

    • Search Google Scholar
    • Export Citation
  • 56.

    Sandeman DR, , Patel N, & Chandler C, et al: Advances in imagedirected neurosurgery: preliminary experience with the ISG viewing wand compared with Leksell G frame. Br J Neurosurg 8:529544, 1994 Sandeman DR, Patel N, Chandler C, et al: Advances in imagedirected neurosurgery: preliminary experience with the ISG viewing wand compared with Leksell G frame. Br J Neurosurg 8:529–544, 1994

    • Search Google Scholar
    • Export Citation
  • 57.

    Sjölander U, , Lindgren PG, & Hugosson R: Ultrasound sector scanning for the localization and biopsy of intracerebral lesions. J Neurosurg 58:710, 1983 Sjölander U, Lindgren PG, Hugosson R: Ultrasound sector scanning for the localization and biopsy of intracerebral lesions. J Neurosurg 58:7–10, 1983

    • Search Google Scholar
    • Export Citation
  • 58.

    Steiner CP, , Kelly DC, & Barnett GH: Comparison of active optical digitizers and sonic 3-D digitizers in the operating room. J Neurosurg 80:401, 1994 (Abstract) Steiner CP, Kelly DC, Barnett GH: Comparison of active optical digitizers and sonic 3-D digitizers in the operating room. J Neurosurg 80:401, 1994 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 59.

    Wang MY, , Maurer CR Jr, & Fitzpatrick JM, et al: An automatic technique for finding and localizing externally attached markers in CT and MR volume images of the head. IEEE Trans Biomed Eng 43:627637, 1996 Wang MY, Maurer CR Jr, Fitzpatrick JM, et al: An automatic technique for finding and localizing externally attached markers in CT and MR volume images of the head. IEEE Trans Biomed Eng 43:627–637, 1996

    • Search Google Scholar
    • Export Citation
  • 60.

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

    • Search Google Scholar
    • Export Citation
  • 61.

    Wen DY, , Hall WA, & Miller DA, et al: Targeted brain biopsy: a comparison of freehand computed tomography-guided and stereotactic techniques. Neurosurgery 32:407413, 1993 Wen DY, Hall WA, Miller DA, et al: Targeted brain biopsy: a comparison of freehand computed tomography-guided and stereotactic techniques. Neurosurgery 32:407–413, 1993

    • Search Google Scholar
    • Export Citation
  • 62.

    Whiting DM, , Barnett GH, & Estes ML, et al: Stereotactic biopsy of non-neoplastic lesions in adults. Cleve Clin J Med 59:4855, 1992 Whiting DM, Barnett GH, Estes ML, et al: Stereotactic biopsy of non-neoplastic lesions in adults. Cleve Clin J Med 59:48–55, 1992

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 498 212 8
Full Text Views 236 16 1
PDF Downloads 138 8 0
EPUB Downloads 0 0 0